Thoracic Epidural Analgesia: Does It Enhance Recovery?

Rosen, David R.; Wolfe, Rachel C.; Damle, Aneel; Atallah, Chady; Chapman, William C.; Vetter, Joel; Mutch, Matthew G.; Hunt, Steven R.; Glasgow, Sean C.; Wise, Paul E.; Smith, Radhika; Silviera, Matthew L.

doi:10.1097/dcr.0000000000001226

Cited by 16 publications

(7 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the study by Rosen et al (2018) 15 showed that, in the context of multimodal analgesia following the ERAS protocol, the use of epidural anesthesia had no impact on the length of stay or consumption of opioids in-hospital after colorectal surgeries, as we noted in our study that the patients in both groups had the same hospital discharge time due to their aptitude for this, with average pain without significant differences, as well as the presence of a return of gastrointestinal motility, confirming the finding of the Cochrane systematic review (2016) 12 in which there was very low quality evidence, showing that an epidural anesthesia containing a local anesthetic could reduce the hospital stay for open surgery.…”

Section: Discussionmentioning

confidence: 97%

Roux-in-Y Gastrojejunal Bypass: Which Anesthetic Technique Has Best Results?

Ruzzon

Nassif

Prigol

et al. 2021

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

Background: As the number of bariatric operations increases, there is a greater interest in knowledge, experience and skills in the operative and anesthetic management of obese people. Anesthetic recovery is an important point in the therapeutic approach and less adverse effects delaying discharge of these patients are necessary to be kept in mind by the surgical team. Aim: To compare anesthetic-analgesic techniques in the opioid-sparing era through epidural administration of local anesthetic associated with low-dose morphine vs. clonidine and analyze the impact of analgesia on the effectiveness of postoperative recovery by comparing these two techniques. Methods: Randomized, double-blind clinical trial with 66 patients candidates for Roux-en-Y gastrojejunal bypass divided into two groups: morphine group and clonidine group. Multimodal analgesia included epidural anesthesia with 0.375% ropivacaine 20 ml at the eighth thoracic vertebra with the association of morphine (morphine group) at a dose of 15 mcg / kg or clonidine (clonidine group) at a dose of 1 mcg / kg. Results: The groups were homogeneous and statistical significance was found when analyzing the difference in pain between them in the first postoperative period. The pain was higher in the clonidine group, as in this period, analgesic rescue was also better in this group. In the other times, there was no significance in the differences regarding pain and rescue. The return of intestinal motility in the morphine group was earlier in the first postoperative period. Nausea, vomiting and hospital discharge did not show significant differences between groups. Conclusion: Epidural anesthesia with low-dose morphine allowed less pain during the entire hospital stay, with a positive impact on patient recovery.

show abstract

Section: Discussionmentioning

confidence: 97%

Roux-in-Y Gastrojejunal Bypass: Which Anesthetic Technique Has Best Results?

Ruzzon

Nassif

Prigol

et al. 2021

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

show abstract

“…However, the effectiveness of epidurals has to be investigated regarding MIS and fast track. A reduced length of stay was demonstrated for open surgery only but not for MIS [31]; furthermore, there is single-center acquired data suggesting no significant effect of epidurals on opioid consumption and length of stay after colorectal surgery regardless of the surgical technique which leads these authors to exclude epidural anesthesia from their fast-track protocols [62]. Considering the technical challenge of placing a thoracic epidural catheter and its side effects like urinary retention which might hinder patients' mobilization, there is emerging use of alternative procedures.…”

Section: Epidural Cathetermentioning

confidence: 99%

State-of-the-art colorectal disease: postoperative ileus

Sommer

Schneider

Wehner

et al. 2021

Int J Colorectal Dis

View full text Add to dashboard Cite

Purpose Postoperative Ileus (POI) remains an important complication for patients after abdominal surgery with an incidence of 10–27% representing an everyday issue for abdominal surgeons. It accounts for patients’ discomfort, increased morbidity, prolonged hospital stays, and a high economic burden. This review outlines the current understanding of POI pathophysiology and focuses on preventive treatments that have proven to be effective or at least show promising effects. Methods Pathophysiology and recommendations for POI treatment are summarized on the basis of a selective literature review. Results While a lot of therapies have been researched over the past decades, many of them failed to prove successful in meta-analyses. To date, there is no evidence-based treatment once POI has manifested. In the era of enhanced recovery after surgery or fast track regimes, a few approaches show a beneficial effect in preventing POI: multimodal, opioid-sparing analgesia with placement of epidural catheters or transverse abdominis plane block; μ-opioid-receptor antagonists; and goal-directed fluid therapy and in general the use of minimally invasive surgery. Conclusion The results of different studies are often contradictory, as a concise definition of POI and reliable surrogate endpoints are still absent. These will be needed to advance POI research and provide clinicians with consistent data to improve the treatment strategies.

show abstract

“…On the contrary, several studies which evaluated incorporating TEA as a component on MMA for laparoscopic colorectal surgeries and thoracic surgeries did not find any additional benefit of TEA. [15][16][17] In a dose ranging from 200-300 μg, a single dose of intrathecal morphine (ITM) has been found superior to MMA including systemic opioids in patients undergoing colonic surgeries, hepato-pancreatic-biliary Category of surgery Various regional anaesthesia techniques 33] Studies have demonstrated that a continuous TAP infusion is non-inferior to continuous TEA in patients undergoing colorectal surgeries. Single-shot TAP block was found to provide improved postoperative analgesia after LSCS which was although lesser compared to ITM, but had lesser side effects when compared to ITM.…”

Section: Available Evidence Regarding Implementation Of Ra In Erasmentioning

confidence: 99%

Regional Anaesthesia in Enhanced Recovery After Surgery Pathways – A Quintessential Component

Nair¹,

Diwan²

2021

IJRA

View full text Add to dashboard Cite

Enhanced recovery after surgery (ERAS) is a multimodal, perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. [1] Initially described by Henry Kehlet in 1995 for colonic surgeries, the enhanced recovery pathways have now evolved and are now validated for more than 30 different types of surgery which include but are not limited to emergency laparotomy, neonatal surgeries, and lower segment cesarean sections. [2] Not only is the patient benefited from this by having an enhanced recovery and early discharge from the hospital, the cost of treatment is reduced and also leads to more turnover of patients thereby reducing the waiting list of patients scheduled for various surgeries. [3]

show abstract

Thoracic Epidural Analgesia: Does It Enhance Recovery?

Cited by 16 publications

References 27 publications

Roux-in-Y Gastrojejunal Bypass: Which Anesthetic Technique Has Best Results?

Roux-in-Y Gastrojejunal Bypass: Which Anesthetic Technique Has Best Results?

State-of-the-art colorectal disease: postoperative ileus

Regional Anaesthesia in Enhanced Recovery After Surgery Pathways – A Quintessential Component

Contact Info

Product

Resources

About