The safety of epidurals placed during general anesthesia

Krane, Elliot J.; Dalens, B; Murat, I.; Murrell, David J.

doi:10.1016/s1098-7339(98)90023-2

Cited by 186 publications

(62 citation statements)

References 22 publications

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“…18 On the other hand, current recommendations in a perioperative controlled setting do not favour the performance of epidural analgesia in intubated and anesthetized patients because of the suboptimal neurological evaluation due to their altered level of consciousness. [44][45][46] Therefore, for safety reasons, epidural analgesia is relatively contraindicated in sedated patients under mechanical ventilation, a population that might potentially benefit from an improvement of their respiratory function and better pain control. Considering these recommendations and the potential for rare, but major, adverse events of this intervention, 26,27 clinically significant benefits, other than better pain control, need to be demonstrated to endorse the use of epidural analgesia as a standard of care in adult patients with traumatic rib fractures.…”

Section: Discussionmentioning

confidence: 99%

L’effet de l’analgésie péridurale chez les patients présentant des fractures de côtes multiples: une revue systématique et une méta-analyse des essais randomisés contrôlés

Carrier

Turgeon

Nicole

et al. 2009

Can J Anesth/J Can Anesth

166

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Purpose A consensus group recently proposed epidural analgesia as the optimal analgesic modality for patients with multiple traumatic rib fractures. However, its beneficial effects are not consistently recognized in the literature. We performed a systematic review and a meta-analysis of randomized controlled trials (RCT) of epidural analgesia in adult patients with traumatic rib fractures. Methods A systematic search strategy was applied to MEDLINE, EMBASE, the Cochrane Library and to the annual meeting of relevant societies (up to July 2008). All randomized controlled trials comparing epidural analgesia with other analgesic modalities in adult patients with traumatic rib fractures were included. Primary outcomes were mortality, ICU length of stay (LOS), hospital LOS and duration of mechanical ventilation. Results Eight studies (232 patients) met eligibility criteria. Epidural analgesia did not significantly affect mortality (odds ratio [OR] 1.6, 95% CI, 0.3, 9.3, 3 studies, n = 89), ICU LOS (weighted mean difference [WMD] -3.7 days, 95% CI, -11.4, 4.0, 4 studies, n = 135), hospital LOS (WMD -6.7, 95% CI, -19.8, 6.4, 4 studies, n = 140) or duration of mechanical ventilation (WMD -7.5, 95% CI, -16.3, 1.2, 3 studies, n = 101). Duration of mechanical ventilation was decreased when only studies using thoracic epidural analgesia with local anesthetics were evaluated (WMD -4.2, 95% CI, -5.5, -2.9, 2 studies, n = 73). However, hypotension was significantly associated with the use of thoracic epidural analgesia with local anesthetics (OR 13.76, 95% CI, 2.89, 65.51, 3 studies, n = 99).Abstract presentation: Presented in part at the Residents' Competition at the 62nd Annual Meeting of the Canadian Anesthesiologists' Society,

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Section: Discussionmentioning

confidence: 99%

L’effet de l’analgésie péridurale chez les patients présentant des fractures de côtes multiples: une revue systématique et une méta-analyse des essais randomisés contrôlés

Carrier

Turgeon

Nicole

et al. 2009

Can J Anesth/J Can Anesth

166

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“…1 In contrast, epidural anesthesia is commonly performed under sedation or general anesthesia in pediatric patients for a number of practical reasons. 2,3 Paresthesia and pain on injection are early warning signs of the presence of a needle in the vicinity of a nerve root or the spinal cord in awake patients, but we cannot use these valuable signs in anesthetized patients. 1 As a result, there is considerable apprehension about performing central neuraxial blockade in anesthetized or heavily sedated patients because of the potential for neurological complications.…”

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confidence: 99%

The threshold current in the intrathecal space to elicit motor response is lower and does not overlap that in the epidural space: a porcine model

Tsui

Wagner

Finucane

2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Using electrical epidural stimulation, a current of 1 to 10 mA is required to confirm the presence of the tip of an epidural catheter in the epidural space. The purpose of this study was to examine the hypothesis that the threshold current required to elicit a motor response in the intrathecal space is significantly lower than that in the epidural space in a porcine model.

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“…The risk of dural sac puncture is higher in ILESI compared to TFESI and CESI [31,36]. Another complication that patients who receive ILESI are at risk for is trauma to the spinal cord [104][105][106]. It has been reported that in 2.5% of patients who underwent lumbar epidural steroid injections there was hypotension due to sympathetic efferent blockade [107,108].…”

Section: Complicationsmentioning

confidence: 99%

Lumbar Epidural Injections: Review of Efficacy and Discussion of Practice Options

2015

J Orth Rheumatol

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Background: In the United States, low back pain remains a common problem and a number one reason to see a physician in the outpatient setting. Etiology is complex and likely multifactorial and includes; degenerative disc disease, zygapophysial joint arthritis, vertebral misalignment, muscle strain, ligament sprain, myofascial pain, among others. Based on evidence of increased inflammatory response in disc herniation and degenerative discs, epidural steroid injections (ESI) have been used to treat lumbosacral radicular pain. Objective:To focus on the appropriate use of lumbar ESI in treating lumbosacral radicular pain in the United States, comparing and contrasting transforaminal, interlaminar, and caudal approaches for steroid delivery, as well as a comparison of commonly used steroid preparations.Methods: PubMED, MEDLINE, and OVID databases were reviewed utilizing the following subject headings: low back pain, epidural steroid injections, transforaminal epidural steroid injections (TFESI), interlaminar epidural steroid injections (ILESI), and caudal epidural steroid injections (CESI) dated from 2000 to 2014. The bibliographies of major articles and reviews were also cross-referenced for additional sources.Results: A number of articles that included randomized control trials, comprehensive and systematic reviews, and meta-analyses were found. These provided a broad, detailed overview of the subject, that we used to explore the data surrounding use of ESI for treatment of lumbosacral radicular pain. Conclusions:Most agree that the evidence for epidural steroid injection efficacy is strongest for short term relief of lumbosacral radicular pain. Most of the systemic reviews have agreed that the strongest evidence for TFESI use is for relief of unilateral lumbosacral radicular pain. The evidence suggests using ILESI in patients with bilateral and/ or multi-level lumbosacral radicular pain. The data correlates efficacy of CESI in low level bilateral or multilevel lumbosacral radicular pain as well as in patients with history of lumbar surgery. Introduction EpidemiologyIn the United States, low back pain remains common. Approximately two-thirds of the population has low back pain at some time in their lives and approximately 26% of adults surveyed admit to having low back pain within the last three months [1]. Back pain is the fifth most common reason for all physician visits [2] and the second most common symptom-related reason for clinician visits [3,4]. The 2010 Global Burden of Disease (GBD) results showed that there is a very high prevalence and burden from low back pain throughout the world [5]. Low back pain was found to have the sixth highest burden of the 291 conditions studied, and caused more disability than any other condition. It is well known that back pain accounts for a large proportion of health care expenditures and that these expenditures have been increasing substantially [6]. In fact, these expenditures have been increasing more rapidly than overall health expenditures [6]. Taken together ...

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The safety of epidurals placed during general anesthesia

Cited by 186 publications

References 22 publications

L’effet de l’analgésie péridurale chez les patients présentant des fractures de côtes multiples: une revue systématique et une méta-analyse des essais randomisés contrôlés

L’effet de l’analgésie péridurale chez les patients présentant des fractures de côtes multiples: une revue systématique et une méta-analyse des essais randomisés contrôlés

The threshold current in the intrathecal space to elicit motor response is lower and does not overlap that in the epidural space: a porcine model

Lumbar Epidural Injections: Review of Efficacy and Discussion of Practice Options

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