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Analgesia And Anesthesia
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Michele Mele, Valentina Bellussi, Laura Felder
Medications injected into the epidural space have a relatively slow analgesic onset of 8–15 minutes. Block height is determined by the volume of medication injected into the epidural space. Injecting low-concentration local anesthetic produces analgesia, and injecting high-concentration local anesthetic produces anesthesia.
Anesthesia and analgesia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Epidural analgesia involves the placement of local anesthetics often combined with low-dose opioids in the epidural space via a small-gauge catheter. The posterior epidural space is bound by the ligamentum flavum posteriorly and the dura anteriorly. Typically, the patient is placed in a sitting or lateral decubitus position. The lumbar approach is commonly used, most often L2 to L5. Following an aseptic technique with local anesthetic injected at the chosen interspace, an epidural needle is inserted into the epidural space utilizing a “loss of resistance” technique with a syringe filled with saline or air. An epidural catheter is then threaded into the epidural space and the needle is removed. The catheter is then secured and local anesthetic infused until an appropriate level of analgesia is achieved. Since the epidural catheter can be placed intravascularly or in the subarachnoid space, a test dose is performed to rule out placement at these sites. A small dose of local anesthetic with epinephrine is injected via the catheter following careful aspiration. Typical test doses include 45mg of lidocaine and 15mcg of epinephrine. If injected IV the small dose of epinephrine will cause a transient maternal tachycardia. If injected into the subarachnoid space, the parturient will develop a limited motor block. Neither of these responses will occur if the catheter is in the epidural space.
Epidural and Intrathecal Analgesia
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Blockade of autonomic and motor fibers as well as sensory nerves may result in the other side effects discussed later. An even more extreme side effect is the so-called total spinal anesthesia, which is due to inadvertent intrathecal administration of much larger doses that were intended for injection into the epidural space. Unconsciousness and cardiovascular collapse may occur rapidly and require immediate and appropriate resuscitation.
Analgesic effect of adding calcitonin to bupivacaine in erector spine plane block for breast surgery, a double blind randomised study
Published in Egyptian Journal of Anaesthesia, 2023
Mona Gad Mostafa Elebieby, Mohammed Nashaat Mohammd, Khaled Abdelwahab, Emadeldeen Hamed, Zenat Eldadamony Mohamed Eldadamony
In this randomized, controlled study, we found that adding calcitonin to bupivacaine in an erector spinae myofascial plane block for cancer breast surgery was linked to better postoperative pain relief and a lessening of inflammatory mediators. ESPB can provide postoperative analgesia for either abdominal or thoracic surgery, depending on the location level. We targeted the transverse process of T5 as a site to inject the local anesthetics. A significant number of studies analysed the block and considered it safe, effective, and comparable for paravertebral and epidural postoperative analgesia, and it inhibited inflammatory reactions [7,8]. In a study by Gabopoulou et al., it was determined that patients who received calcitonin in epidural space experienced little to no postoperative discomfort (VAS less than 4) after having total hip arthroplasty under epidural anaesthesia [15]. In their investigation on the use of subarachnoid and epidural injections of calcitonin in patients with metastatic cancer pain, Maytorena et al. reported that considerable pain alleviation was experienced following calcitonin injection in the epidural space of patients who had failed to respond to conventional therapy [16].
Postoperative analgesic effect of dexmedetomidine combined with TPVB applied to open gastrectomy for gastric cancer
Published in Immunopharmacology and Immunotoxicology, 2023
Weilan Wan, Zhiqi Hou, Qiuying Qiu
Currently, patient-controlled analgesia (PCA) system is a commonly used postoperative analgesia mode, which administration is more accurate and follows the principle of individualization [5]. However, the postoperative analgesic effect of PCA alone is often not satisfactory in traumatic operations such as gastrectomy [5]. Epidural analgesia is regarded as the gold standard for the analgesia of abdominal and thoracic surgeries [6]. The local anesthetics act upon the spinal nerve roots in epidural space directly, block the introduction of pain stimulation, and thus provide good analgesic effect for postoperative operation [7]. Although epidural analgesia has many advantages, some limitations such as spinal nerve injury and epidural hematoma infection are also possible [8]. In recent years, epidural analgesia has been gradually replaced by other analgesia methods [9]. Yeung et al. indicated that thoracic paravertebral nerve block (TPVB) has the same analgesic effect as epidural block, but reduced the risks of developing minor complications [10]. Additionally, compared with epidural block, TPVB has a wider scope of application and can maintain hemodynamic stability, which is conducive to rapid postoperative recovery [11,12]. It has been used in some upper abdominal surgeries, such as hepatectomy [13] and nephrectomy [14]. However, there are relatively rare researches on TPVB for GC surgery.
Safety of treatment options available for postoperative pain
Published in Expert Opinion on Drug Safety, 2021
Zhaosheng Jin, Christopher Lee, Kalissa Zhang, Tong J Gan, Sergio D Bergese
Epidural analgesia is one of the first regional anesthesia techniques conceived, and involves the delivery of local anesthetics to the epidural space, which targets the nerve roots as they exit the spinal dura sheath. One of the main concerns of epidural analgesia is the risk of unintentional dura puncture, which can lead to post-dural puncture headache; other risks include epidural hematoma and epidural abscess. Our institution previously published a ten-year cross-sectional study based on the obstetric population, which reported that the risk of post-dural puncture headache risk with labor epidural was 0.9% [72]. Katircioglu et al. reported 35,628 cases of epidural analgesia in patients undergoing gynecological procedures as well as labor and delivery, they reported 0.1% incidence of overt cerebral spinal fluids leak, as well as 0.01% risk of seizure and neurogenic bladder [73].