Kardioprotektion durch thorakale Periduralanästhesie?

Jahn, Stefanie; Eberhart, Leopold; Stahl, W.; Rockemann, M.; Georgieff, Michael; Wagner, F.; Meierhenrich, Rainer

doi:10.1007/s00101-011-1941-9

Cited by 20 publications

(8 citation statements)

References 72 publications

(54 reference statements)

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“…SA patients had an increased incidence miction if a postoperative catheter is not used. Continuing urinary dysfunction may be the result of neurological damage (6). In the present study, patients under SA did not need additional anesthesia.…”

Section: Discussionmentioning

confidence: 57%

Lumbar microdiscectomy under spinal and general anesthesia: a comparative study

Dağıstan¹,

Ökmen²,

Dağıstan³

et al. 2014

Turkish Neurosurgery

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AIm:To compare the safety and efficacy of spinal anesthesia (SA) in patients undergoing lumbar microdiscectomy (LM). mAterIAl and methOds:We evaluated 180 patients who underwent LM between 1 January 2012 and 5 July 2013. Demographic, clinical, laboratory, and pre-, intra-, and postoperative information was determined from the patients' medical records. results:Total anesthetic times were longer in the general anesthesia (GA) group. There was less bleeding at the surgical site in the SA group. Intraoperative blood pressure was significantly also lower in the SA group. Meanwhile, tachycardia was significantly higher in the GA group. The analgesic requirement in post-anesthesia care unit (PACU) was higher in the general anesthesia group. At PACU admission, analgesic requirement, heart rate, and the mean arterial pressure were higher in the GA group. Postoperative nausea and vomiting was more frequent among patients recovering in general anesthesia group. SA patients had an increased incidence of urinary retention compared with GA patients. Pulmonary complications requiring specific treatment were insignificantly higher among GA patients. COnClusIOn:In patients who undergo lumbar disc surgery, SA is a good alternative for experienced surgeons because of a more comfortable healing process.

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Section: Discussionmentioning

confidence: 57%

Lumbar microdiscectomy under spinal and general anesthesia: a comparative study

Dağıstan¹,

Ökmen²,

Dağıstan³

et al. 2014

Turkish Neurosurgery

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“…However, we have shown no difference in the evaluation of serum CK-MB, troponin values or ST segment analysis in a period of 24 hours postoperatively. In a recent meta-analysis including 2,758 patients and nine studies, it was demonstrated that TEA did not reduce perioperative myocardial ischemia or mortality in patients undergoing noncardiac operations [9]. However, there are limited data on perioperative outcome comparisons of patients undergoing thoracotomy procedure who had either a lumbar or thoracic epidural for postoperative pain management.…”

Section: Discussionmentioning

confidence: 99%

A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

et al. 2014

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BackgroundWe aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations.MethodsOne hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively.ResultsThe VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24-hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group.ConclusionsTEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile.

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“…Only weak evidence exists that EDA is able to decrease postoperative cardiovascular and pulmonary complications for subgroups with major open vascular surgery or high-risk patients [ 23 , 27 ]. A 2011 meta-analysis investigating the effects of thoracic EDA on perioperative outcome failed to show a benefit on perioperative in-hospital mortality in noncardiac surgery [ 7 ]. In a single-center RCT, the preemptive use of EDA in patients undergoing open colon resection offered no advantage over IV-PCA with regard to the length of the hospital stay, pain scores, quality of life, complications, or hospital costs [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Major abdominal surgery frequently entails large volume shifts and significant blood losses. Some evidence exists that EDA provokes hemodynamic instability in this setting [ 6 , 7 ]. Typically, vasopressors and large amounts of fluids are administered to counteract undesirable hypotension.…”

Section: Introductionmentioning

confidence: 99%

Intravenous versus epidural analgesia to reduce the incidence of gastrointestinal complications after elective pancreatoduodenectomy (the PAKMAN trial, DRKS 00007784): study protocol for a randomized controlled trial

Klotz

Hofer

Schellhaaß

et al. 2016

Trials

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BackgroundDespite substantial improvements in surgical and anesthesiological practices leading to decreased mortality of less than 5 % at high-volume centers, pancreatic surgery is still associated with high morbidity rates of up to 50 %. Attention is increasingly directed toward the optimization of perioperative management to reduce complications and enhance postoperative recovery. Currently, two different strategies for postoperative pain management after pancreatoduodenectomy are being routinely used: patient-controlled intravenous analgesia and thoracic epidural analgesia. Evidence is lacking to assess which strategy entails fewer postoperative complications.Methods/designThe PAKMAN trial is designed as an adaptive, pragmatic, randomized, controlled, multicenter, open-label, superiority trial with two parallel study groups. A total of 370 patients scheduled for elective pancreatoduodenectomy will be randomized after giving written informed consent, and 278 patients are needed for analysis. Patients with chronic pancreatitis, severe chronic obstructive pulmonary disease (COPD), American Society of Anesthesiologists (ASA) physical status classification ≥ IV, or chronic pain syndrome will be excluded. The group A intervention includes intraoperative general anesthesia and postoperative patient-controlled intravenous analgesia; the group B intervention comprises combined intraoperative general anesthesia and epidural analgesia with postoperative epidural analgesia. The primary endpoint of this trial is a composite of the gastrointestinal complications (delayed gastric emptying, pancreatic fistula, biliary leak, gastrointestinal bleeding, and postoperative ileus) up to postoperative day 30. The aim is to investigate whether the frequency of gastrointestinal complications following pancreatoduodenectomy can be reduced by 15 % using postoperative, patient-controlled intravenous analgesia compared with epidural analgesia.DiscussionSeveral previous studies investigating the two different strategies for postoperative pain management have mainly focused on their effectiveness in pain control. However, the PAKMAN trial is the first to compare them with regard to their impact on the surgical endpoint “postoperative gastrointestinal complications” after pancreatoduodenectomy.Trial registrationGerman Clinical Trials Register, DRKS00007784Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1306-4) contains supplementary material, which is available to authorized users.

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Kardioprotektion durch thorakale Periduralanästhesie?

Abstract: The present meta-analysis did not prove any positive influence of thoracic EDA on perioperative in-hospital mortality in patients undergoing noncardiac surgery. Furthermore, it remains questionable if thoracic EDA has the potential to reduce the rate of perioperative myocardial infarction.

Cited by 20 publications

References 72 publications

Lumbar microdiscectomy under spinal and general anesthesia: a comparative study

Lumbar microdiscectomy under spinal and general anesthesia: a comparative study

A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

Intravenous versus epidural analgesia to reduce the incidence of gastrointestinal complications after elective pancreatoduodenectomy (the PAKMAN trial, DRKS 00007784): study protocol for a randomized controlled trial

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