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Epidural Infusion (epidural + infusion)
Kinds of Epidural Infusion Selected AbstractsEpidural Infusion of Opiates and Local Anesthetics for Complex Regional Pain SyndromePAIN PRACTICE, Issue 2 2002Sami Moufawad MD CRPS-I consists of multiple signs, including autonomic dysfunction, in the form of edema, vasomotor changes, motor dysfunctions, muscle spasms, tremors and dystonia, as well as burning pain, hypersensitivity and allodynia that could present in any combination. The treatment is progressive physical therapy rehabilitation program. Multiple analgesic modalities have been used to facilitate the rehabilitation program with varying rates of success. The most successful treatment is a multi-disciplinary comprehensive approach, where initial pain control allows for physical and psychological interventions that are believed to be the basis for successful treatment.1 The pain in CRPS-I may be mediated through the sympathetic nervous system, sympathetic maintained pain (SMP) or sympathetic independent pain (SIP)2. [source] The BCH Epidural System, a safe system for epidural infusion analgesia in childrenPEDIATRIC ANESTHESIA, Issue 9 2002N. Llewellyn Epidural infusions in children are usually delivered by syringe drivers because of the lower volumes of local anaesthetic solutions used in children rather than in adult practice. Recently concern has arisen both via the media and anecdotally over a number of adverse events associated with intravenous administration of bupivacaine. We have designed and validated a system that should significantly reduce the possibility and incidence of this adverse effect. (1) [ The system is based on the reversal of the standard luer-lock system. ] A female 60 cc syringe is connected to a reversed 150 cm infusion line that is connected to a male epidural filter. The filter connects with standard epidural infusion catheters. The reversal of the luer-lock system requires that devices are also available for the initial doses of local anaesthetic, for the preparation of the epidural infusion syringe and for administration of rescue boluses of local anaesthetic. With this system it is extremely unlikely that the epidural syringe or infusion catheter can be connected to an intravenous line. It is also less likely that intravenous drugs may be connected to the epidural filter. [source] Continuous lumbar epidural infusion of levobupivacaine: effects of small-or large-volume regimen of infusionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009G. DANELLI Background: The question of whether the dose, concentration or volume of a local anesthetic solution is the relevant determinant of the spread and quality of post-operative epidural analgesia is still open. In this prospective, randomized, double-blind study, we compared the effects of a large volume,low concentration with a small-volume,high-concentration lumbar epidural infusion of levobupivacaine. Methods: Seventy patients scheduled for total hip replacement were enrolled. After surgery, patients were randomly allocated to receive a continuous epidural infusion of levobupivacaine (10.5 mg/h) using either 0.125% levobupivacaine infused at 8.4 ml/h (low concentration group, n=35) or 0.75% levobupivacaine infused at 1.4 ml/h (high concentration group, n=35). We blindly recorded the degree of pain relief at rest and during movement every 8 h for the first two post-operative days, as well as hip flexion, motor block, rescue analgesic consumption and adverse events. Results: No difference in pain relief was observed between groups as estimated with the areas under the curve of the verbal Numerical Rating Scale for pain over time, both at rest and during movement. Similarly, there was no difference between groups in hip flexion degree, motor blockade and hemodynamic stability. Conclusions: Continuous lumbar epidural infusion of 0.75% levobupivacaine was as effective as continuous lumbar epidural infusion of 0.125% levobupivacaine, when administered at the same hourly dose of 10.5 mg, in achieving adequate analgesia both at rest and during movement, without differences in the incidence of hypotension and motor blockade. [source] Modulation of the inflammatory response to cardiopulmonary bypass by dopexamine and epidural anesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2002F. Bach Background: Cardiopulmonary bypass (CPB) induces a systemic inflammatory reaction. Microcirculation-dependent alteration of the gut mucosal barrier with subsequent translocation of endotoxins is a postulated mechanism for this inflammatory response. This study was designed to elucidate whether two different approaches to modulate splanchnic perfusion may influence systemic inflammation to CPB. Methods: We examined 40 patients scheduled for elective coronary bypass surgery in a prospective, randomized study. One group (DPX) received dopexamine (1 µg · kg,1 · min,1) continuously after induction of anesthesia until 18 h after CPB. The control group (CON) received equal volumes of NaCl 0.9% in a time-matched fashion. In a third group (EPI) a continuous epidural infusion of bupivacaine 0.25% [(body height (cm) , 100) · 10,1=ml·h,1] was administered for the whole study period. Procalcitonin (PCT), tumor necrosis factor (TNF-,), soluble TNF receptor, human soluble intercellular adhesion molecule-1, C-reactive protein (CRP) and leukocyte count were measured as parameters of inflammation. Results: All parameters significantly increased following CPB. Increases of PCT, TNF-, and leukocyte count were significantly attenuated in the DPX and EPI groups at different time points. However, neither splanchnic blood flow nor oxygen delivery and consumption were different when compared with the CON-group. Conclusion: These results do suggest that mechanisms other than an improved splanchnic blood flow by DPX and EPI treatment have to be considered for the anti-inflammatory effects. [source] An acute pain service improves postoperative pain management for children undergoing selective dorsal rhizotomyPEDIATRIC ANESTHESIA, Issue 12 2009CHANTAL FRIGON MSC MD Summary Background:, A continuous epidural infusion of morphine is the pain treatment modality for children undergoing selective dorsal rhizotomy (SDR) in our institution. The aim of the study was to evaluate the impact of having an organized acute pain service (APS) on postoperative pain management of these children. Methods:, We conducted a retrospective cohort study using anesthetic records and the APS database to compare the postoperative pain management of children undergoing SDR before and after the introduction of the APS at the Montreal Children's Hospital in April 2001. Ninety-two consecutive children who had their surgery between January 1997 and July 2006 were included. We collected data regarding postoperative pain, opioid-induced side effects, complications (sedation, desaturations < 92%), and hospital length of stay. Results:, Pain scores were documented more frequently after the implementation of the APS (61% vs 48.5%). Sedation scores were documented only after the implementation of the APS. Postoperative desaturation was significantly more frequent in the pre-APS group compared to the APS group (45.5% vs 6.8%, P < 0.001). Despite the fact that the epidural catheter was in place for the same duration for both groups [median of 3 days (3,3 25,75%ile)], the duration of hospitalization was 1 day shorter in the APS group compared to the pre-APS group [median of 5 (5,5 25,75%ile) vs 6 (5,6 25,75%ile) days, P < 0.001]. Conclusions:, Although we recognize that it is possible that there were changes in care not related specifically to the introduction of a dedicated APS that occurred in our institution that resulted in improvements in general postoperative care and in length of stay, our study did show that having an organized APS allowed to significantly decrease the incidence of postoperative oxygen desaturation and to decrease the hospital length of stay by 1 day. [source] Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric casesPEDIATRIC ANESTHESIA, Issue 3 2001Corinne Lejus MD Background: The objective of this prospective study was the evaluation of the analgesia provided by an epidural infusion of bupivacaine and fentanyl after different types of surgery in children. Methods: Data were collected from 348 epidural analgesia in 87 children below 2 years of age, in 80 children between 2 and 6 years and 181 above 6 years of age, for a median duration of 43 postoperative hours. Bupivacaine (mean concentration 0.185%) and fentanyl (5 ,g·kg,1·day,1) were administered on the surgical ward. Results: Pain control was considered excellent in 86% of the 11 072 pain hourly assessments. Analgesia was found to be better for children older than 2 years, and the overall quality of their night's sleep was better than that of older children. Higher pain scores were noted for Nissen fundoplication surgery and club foot repairs. Early discontinuation rarely occurred, and only because of technical problems with the epidural catheter (4%) or insufficient analgesia (6%). Complications were minor (nausea/vomiting 14%, pruritus 0.6%, urinary retention 17%) and easily reversed. Conclusions: This combination of bupivacaine,fentanyl provides safe analgesia after major surgery in children with frequent clinical monitoring. Regular pain assessments of intensity and duration are useful to improve the quality of postoperative analgesia. [source] Continuous patient-controlled epidural infusion of levobupivacaine plus sufentanil in labouring primiparous women: effects of concentration*ANAESTHESIA, Issue 6 2010S. Tixier Summary The effects of two different concentrations of epidural levobupivacaine were compared when used to provide analgesia for labour. Primiparous women in spontaneous uncomplicated labour were enrolled in a prospective, randomised and partially double-blinded study. The study solutions were either 0.568 mg.ml,1 levobupivacaine (low concentration group) or 1.136 mg.ml,1 levobupivacaine (high concentration group), with sufentanil 0.45 ,g.ml,1 added to both solutions. Epidural analgesia was initiated with 20 ml of the study solution, followed by a standardised algorithm of top-up bolus injections. Epidural analgesia was then continued by self-administered boluses of 5-ml plus a continuous infusion of 5 ml.h,1. Analgesia was found to be more efficacious in the high-concentration group. The dose of levobupivacaine administered was higher and sometimes overstepping recommended limits in the high concentration group, but with no observed increase in side-effects. The choice between these two concentrations may still be made according to the patient's and the practitioner's preferences. The effects of an intermediate concentration should be studied in the future. [source] Audit of motor weakness and premature catheter dislodgement after epidural analgesia in major abdominal surgeryANAESTHESIA, Issue 1 2009I. Königsrainer Summary In a quality improvement audit on epidural analgesia in 300 patients after major abdominal surgery, we identified postoperative lower leg weakness and premature catheter dislodgement as the most frequent causes of premature discontinuation of postoperative epidural infusion. Lower limb motor weakness occurred in more than half of the patients with lumbar epidural analgesia. In a second period monitoring 177 patients, lumbar catheter insertion was abandoned in favour of exclusive thoracic placement for epidural catheters. Additionally, to prevent outward movement, the catheters were inserted deeper into the epidural space (mean (SD) 5.2 (1.5) cm in Period Two vs 4.6 (1.3) cm in Period One). Lower leg motor weakness declined from 14.7% to 5.1% (odds ratio 0.35; 95% confidence interval 0.16,0.74) between the two periods. Similarly, the frequency of premature catheter dislodgement was reduced from 14.5% to 5.7% (odds ratio 0.35; 95% confidence interval 0.17,0.72). With a stepwise logistic regression model we demonstrated that the odds of premature catheter dislodgement was reduced by 43% for each centimetre of additional catheter advancement in Period Two. We conclude that careful audit of specific complications can usefully guide changes in practice that improve success of epidural analgesia regimens. [source] The effect of the Lockit epidural catheter clamp on epidural migration: a controlled trialANAESTHESIA, Issue 9 2001apparatus We investigated the efficacy of using the Lockit epidural catheter clamp in preventing epidural catheter migration in patients receiving postoperative analgesia via an epidural infusion after major surgery. Patients were randomly allocated to receive either a standard epidural dressing, a coiled catheter with transparent adhesive dressing and tape (n = 54), or the Lockit epidural catheter clamp (n = 48). There was no movement from the insertion position in 88% of the Lockit group compared with only 28% in the standard group (p < 0.001). Outward migration of >,2 cm occurred in 26% of the standard group compared with just 6% of the Lockit group (p < 0.01). Inward migration of >,1 cm occurred in 17% of the standard group but in none of the Lockit group (p < 0.01). Catheter migration was assessed as being the cause of analgesic failure in 15% of the standard group but in only 4% of the Lockit group (p < 0.05). We conclude that the Lockit epidural catheter clamp significantly reduces catheter migration in a safe and non-invasive fashion. [source] Management of labour among women with epidural analgesiaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2003Christine L. Roberts Abstract To assess current practices in the labour management of low risk primiparous women with epidural analgesia we surveyed delivery suites in New South Wales (NSW) that annually provide at least 100 epidurals to ,standard primipara'. Epidural rates among ,standard primipara' at these hospitals ranged from 14 to 85% (median 46%). Continuous epidural infusion was the most commonly used technique (63%). For ,standard primipara' with an epidural 62% of units usually augmented labour with oxytocin, 89% discontinued the epidural in second stage and 67% had policies of delayed pushing. There is wide variation in epidural availability and in labour management, perhaps reflecting the limited evidence for effective interventions to reduce any unintended effects of epidural analgesia. [source] Thoracic epidural anaesthesia and analgesia: United Kingdom practiceACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2000F. O'Higgins Background: Thoracic epidural analgesia has become increasingly practised in recent years. Complications are rare but potentially serious and, consequently, careful evaluation is required before undertaking this technique. The practice surrounding this procedure varies widely amongst anaesthetists. Methods: A postal survey to examine the practice of thoracic epidural analgesia was sent to all Royal College of Anaesthetists tutors in the United Kingdom. Results: Responses were received from 240 tutors, representing a return rate of 83%. When obtaining consent for thoracic epidural cannulation, 42% of respondents mentioned risk of a dural tap complication and 11% mentioned neurological damage. Fifty percent of respondents performed epidural cannulation following induction of general anaesthesia. The practice of epidural insertion in patients with abnormal coagulation varied, although over 80% of respondents did not consider concurrent treatment with either aspirin or non-steroidal anti-inflammatory drugs a contraindication. Sterile precautions for epidural insertion also varied between anaesthetists. Postoperatively, 95% of respondents used an opioid-based bupivacaine solution for epidural infusions, and these were most commonly nursed on general surgical wards (63%). Seventy-eight percent of hospitals provided an acute pain team to review epidural analgesia. Conclusion: In the United Kingdom, there is little consensus in the practice of thoracic epidural analgesia relating to the issues of informed consent, epidural cannulation in patients with deranged clotting and the sterile precautions taken prior to performing epidural insertion. Most respondents use an opioid-based bupivacaine solution to provide postoperative epidural analgesia. Most hospitals in the UK now provide an acute pain service for thoracic epidural follow-up. [source] APA national audit of pediatric opioid infusionsPEDIATRIC ANESTHESIA, Issue 2 2010FFPMRCA, FRCPCH, NEIL S. MORTON MD Summary Introduction:, A prospective audit of neonates, infants, and children receiving opioid infusion techniques managed by pediatric acute pain teams from across the United Kingdom and Eire was undertaken over a period of 17 months. The aim was to determine the incidence, nature, and severity of serious clinical incidents (SCIs) associated with the techniques of continuous opioid infusion, patient-controlled analgesia, and nurse-controlled analgesia in patients aged 0,18. Methods:, The audit was funded by the Association of Paediatric Anaesthetists (APA) and performed by the acute pain services of 18 centers throughout the United Kingdom. Data were submitted weekly via a web-based return form designed by the Document Capture Company that documented data on all patients receiving opioid infusions and any SCIs. Eight categories of SCI were identified in advance, and the reported SCIs were graded in terms of severity (Grade 1 (death/permanent harm); Grade 2 (harm but full recovery and resulting in termination of the technique or needing significant intervention); Grade 3 (potential but no actual harm). Data were collected over a period of 17 months (25/06/07-25/11/08) and stored on a secure server for analysis. Results:, Forty-six SCIs were reported in 10 726 opioid infusion techniques. One Grade 1 incident (1 : 10 726) of cardiac arrest occurred and was associated with aspiration pneumonitis and the underlying neurological condition, neurocutaneous melanosis. Twenty-eight Grade 2 incidents (1 : 383) were reported of which half were respiratory depression. The seventeen Grade 3 incidents (1 : 631) were all drug errors because of programming or prescribing errors and were all reported by one center. Conclusions:, The overall incidence of 1 : 10 000 of serious harm with opioid infusion techniques in children is comparable to the risks with pediatric epidural infusions and central blocks identified by two recent UK national audits (1,2). Avoidable factors were identified including prescription and pump programming errors, use of concurrent sedatives or opioids by different routes and overgenerous dosing in infants. Early respiratory depression in patients with specific risk factors, such as young age, neurodevelopmental, respiratory, or cardiac comorbidities, who are receiving nurse-controlled analgesia or continuous opioid infusion suggests that closer monitoring for at least 2 h is needed for these cases. As a result of this audit, we can provide parents with better information on relative risks to help the process of informed consent. [source] The rise and fall of continuous epidural infusions in childrenPEDIATRIC ANESTHESIA, Issue 2 2003George Chalkiadis No abstract is available for this article. [source] | ||||||||||