Thoracic Epidural Analgesia with Low Concentration of Bupivacaine Induces Thoracic and Lumbar Sympathetic Block

Freise, Hendrik; Meißner, Andreas; Lauer, Stefan; Ellger, Björn; Radke, Robert; Bruewer, Matthias; Brodner, G.; Aken, Hugo K. Van; Sielenkämper, Andreas W.; Fischer, Lars

doi:10.1097/aln.0b013e31818db16c

Cited by 44 publications

(39 citation statements)

References 42 publications

(42 reference statements)

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“…Contradictory results have been published regarding skin temperature in the thoracic and abdominal region in patients receiving thoracic epidural anaesthesia. Either no change in skin temperature at the thorax, abdomen or thigh was found, or a decrease was observed . However, all changes described were usually below 1°C, which is most likely explained by the already relatively warm trunk and the little variation in skin blood flow in comparison to the extremities.…”

Section: Thermoregulation During Neuraxial Blocksmentioning

confidence: 91%

Assessment of skin temperature during regional anaesthesia—What the anaesthesiologist should know

Hermanns

Werdehausen

Hollmann

et al. 2018

Acta Anaesthesiol Scand

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Body temperature homeostasis is accurately regulated by complex feedback-driven neuronal mechanisms, which involve a multitude of thermoregulatory pathways. Thus, core temperature is constantly maintained within a narrow range. As one of the most effective regulatory systems skin temperature is dependent on skin blood flow. Skin blood flow in turn is highly dependent on sympathetic activity. Regional anaesthesia leads to blockade not only of somatosensory and motor nerve fibres but also of sympathetic fibres. As a consequence, vasoconstrictor tonic activity is abrogated and a vasodilation leads to an increase in skin blood flow and temperature. The aim of this review was to summarize the general physiology of thermoregulation and skin temperature as well as the alterations during regional anaesthesia. The main focus was the usefulness of measuring skin temperature as an indicator of regional anaesthesia success. According to the available literature, assessment of skin temperature can indeed serve to predict success of regional anaesthesia. Hence, it is important to realize that relevant and reliable temperature increase is only seen in the most distal body parts, ie fingers and toes. More proximally, temperature changes are frequently small and inconsistent, which means that assessment of block levels is not possible by temperature measurement. Furthermore, relevant skin temperature increases will only be observed in patients, which are initially vasoconstricted. In conclusion, measurement of skin temperature represents a reliable and feasible diagnostic tool to assess and predict the success or failure of regional anaesthesia procedures, especially in patients in which sensory testing is impossible.

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Section: Thermoregulation During Neuraxial Blocksmentioning

confidence: 91%

Assessment of skin temperature during regional anaesthesia—What the anaesthesiologist should know

Hermanns

Werdehausen

Hollmann

et al. 2018

Acta Anaesthesiol Scand

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“…The patient exhibited a T4 sensory level on exam. This level of analgesia corresponds to blockade of the majority of the cardioaccelerator fibres as sympathectomy has been shown to occur two to three dermatomes above the level of anaesthesia to pinprick [5,8]. Additionally, because the patient's T4 sensory level was confirmed only 15 min after the initial bolus of ropivacaine, continued cranial spread of local anaesthetic effect and sympathectomy likely occurred.…”

Section: Discussionmentioning

confidence: 93%

Development of third-degree heart block due to thoracic epidural anaesthesia

McHugh

Ibinson

2012

Injury Extra

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“…We also demonstrated that perioperative myocardial ischemia was not significantly different between patients receiving either TEA or LEA, which was shown by serum CK-MB, troponin values and ST segment analysis. In a comparison of TEA and LEA in abdominal and thoracic procedures, a significant reduction in myocardial infarction and an improvement of ischemia induced left ventricular global and regional wall motion abnormalities with use of TEA were demonstrated [19-21]. Also, a significantly reduced incidence of supraventricular tachycardia after both cardiac surgery and pulmonary resection with the use of TEA was reported.…”

Section: Discussionmentioning

confidence: 99%

“…Also, a significantly reduced incidence of supraventricular tachycardia after both cardiac surgery and pulmonary resection with the use of TEA was reported. However, we were not able to demonstrate this because we used TEA for postoperative analgesia only and not during the operation [21-23]. A previous study of the use of TEA for postoperative analgesia after thoracotomy is not available for a comparison of the cardioprotective effects of LEA.…”

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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Thoracic Epidural Analgesia with Low Concentration of Bupivacaine Induces Thoracic and Lumbar Sympathetic Block

Abstract: TEA with 10 ml bupivacaine, 0.25%, induced thoracic and lumbar sympathetic block that precedes and exceeds sensory block. Caudal limit of sympathetic block could not be demonstrated in this study.

Cited by 44 publications

References 42 publications

Assessment of skin temperature during regional anaesthesia—What the anaesthesiologist should know

Assessment of skin temperature during regional anaesthesia—What the anaesthesiologist should know

Development of third-degree heart block due to thoracic epidural anaesthesia

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

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