Factors associated with complete outward migration of postoperative epidural analgesia catheters placed for oncologic surgery: A 10-year single-center retrospective study

2016 ◽

Vol 3 (2) ◽

pp. 20-25

Author(s):

Laxmi Pathak

Keyword(s):

Retrospective Study ◽

Postoperative Pain ◽

Epidural Analgesia ◽

Epidural Catheter ◽

Medical Sciences ◽

Study Results ◽

Epidural Catheterization ◽

American Society ◽

Upper Abdominal ◽

Postoperative Epidural Analgesia

INTRODUCTION: Epidural analgesia has been used in many major surgeries like upper abdominal surgery, cardio-thoracic surgery, orthopedic surgery etc. Epidural analgesia is one of the commonly used methods of postoperative pain control despite its associated complications. So, this study was conducted to find out its effectiveness in major orthopedic surgeries done in Universal College of Medical Sciences. MATERIAL AND METHODS: A retrospective study was done at Universal College of Medical Sciences & Teaching Hospital, Bhairahawa, Nepal from July 2012 to June 2014. Data of 57 patients, aged between 17 to 91 years having American Society of Anesthesiologists (ASA) physical status 1 and 2 who had undergone major orthopedic surgeries under spinal anesthesia and lumber epidural catheterization were collected and important information regarding anesthesia and surgery, epidural catheter and postoperative epidural analgesia, any complications if occurred throughout the study period were recorded. Departmental Protocol for epidural analgesia was followed in these patients. Patients who received intraoperative epidural anesthesia or analgesia and any other anesthetic or analgesic agents were excluded in this study. RESULTS: This study found epidural analgesia, a very effective way to relieve pain in patients undergoing major orthopedic surgeries, when given according to the Departmental Protocol. There were no any complications related to epidural analgesia till 4th postoperative day. Out of 57, only 2 patients received injection Ketorolac intravenously as a rescue analgesic at the same day of operation before epidural top up. Average time to demand for analgesic after the last dose of epidural top up was 21.933 hours. All patients were mobilized around their beds on 2nd postoperative day. The average postoperative days of hospital stay was only 6.5 days. CONCLUSION: Epidural mixture of Bupivacaine-morphine in lower dose and concentration given as an intermittent bolus dosing via lumber epidural catheter is safe and very effective in relieving postoperative pain after major orthopedic surgeries without any significant complications.Journal of Universal College of Medical Sciences (2015) Vol.03 No.02 Issue 10

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P029 Background factors associated with the prognosis of patients with Crohn's disease: A single-center, retrospective study

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000578188.71330.93 ◽

2019 ◽

Vol 114 (1) ◽

pp. S8-S8

Author(s):

Ezaki Kaoru

Keyword(s):

Crohn’S Disease ◽

Retrospective Study ◽

Crohn's Disease ◽

Single Center ◽

Background Factors ◽

Factors Associated

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The need for post-operative vasopressor infusions after major gynae-oncologic surgery within an ERAS (Enhanced Recovery After Surgery) pathway

Perioperative Medicine ◽

10.1186/s13741-020-00158-0 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Michèle Bossy ◽

Molly Nyman ◽

Thumuluru Kavitha Madhuri ◽

Anil Tailor ◽

Jayanta Chatterjee ◽

...

Keyword(s):

Blood Loss ◽

Epidural Analgesia ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Case Series ◽

Pelvic Surgery ◽

Oncologic Surgery ◽

Factors Associated ◽

Estimated Blood Loss ◽

Morbidity Score

Abstract Background Hypotension following major abdominal surgery is common, and once hypovolaemia has been optimally treated, is often due to vasodilation which can be treated with vasopressor infusions. There is unpredictability in the dose and duration of post-operative vasopressor infusions, and factors associated with this have not been determined. Methods We present a case series of consecutive patients who received major gynae-oncology surgery delivered within an Enhanced Recovery After Surgery (ERAS) pathway at a single institution. Patients were electively admitted from theatre directly to the intensive care unit (ICU). Data was collected prospectively into electronic databases (Philips ICCA, Wardwatcher) and then retrospectively collated and appropriate statistical analyses were performed. In the absence of a consensus definition of vasoplegia, we, necessarily arbitrarily, chose a noradrenaline dose of > 0.1 mcg/kg/min at 08:00 on the first post-operative day. The rationale is that this would be more than would typically be expected to counteract the vasodilatory effects of epidural analgesia, which is commonly used at our institution. Results Data was collected from 324 patients, all treated between February 2014 and July 2016. The average age was 67 years and 39% received neoadjuvant chemotherapy. The commonest tumour type was ovarian (58%). The median estimated blood loss was 800 ml and epidural analgesia was used in 71%. Fifty per cent received post-operative vasopressor infusions: factors associated with this included epidural use and estimated blood loss. Nineteen per cent met our criteria for vasoplegia: factors associated with this included CRP on post-operative day 1 and P-POSSUM morbidity score. Hospital and ICU length of stay was prolonged in those who had vasoplegia. Conclusions Patients commonly receive vasopressors following major gynae-oncologic surgery, and this can be at relatively high doses. Clinical factors only accounted for a minority of the variability in vasopressor usage—suggesting considerable biological variability. Optimal care of patients having major abdomino-pelvic surgery may include advanced haemodynamic monitoring and ready availability of infused vasopressors, in a suitable environment.

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