scholarly journals P-P18 Thoracic epidural VS intrapleural analgesia for pancreaticoduodenectomy – a study on analgesic and non-analgesic outcomes

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Lu Yao ◽  
N Rajaretnam ◽  
N Smith ◽  
L Massey ◽  
Mark Rockett ◽  
...  
Keyword(s):  
Rectus Sheath ◽  
Electronic Records ◽  
Haemodynamic Instability ◽  
Treatment Unit ◽  
Thoracic Epidural ◽  
Adequate Pain Relief ◽  
Post Operative Pain ◽  
Patient Reported ◽  
Comorbidity Index ◽  
Intrapleural Analgesia

Abstract Background Thoracic epidural analgesia (TEA) has been the traditional option for post-operative pain management for Kausch-Whipple pancreaticoduodenectomy (KWPD) via a ‘reverse L’ incision. An alternative option with inter-pleural analgesia (IPA) has become popular. However, the superior form of analgesia for KWPD regarding analgesic and non-analgesic outcomes is unclear. This study aims to establish if IPA is equivalent to TEA. Methods Retrospective study of all patients who underwent KWPD with ‘reverse L’ incision by a single surgeon between February 2014 to June 2016. All received either IPA or TEA post-operatively; patients who had rectus sheath catheter and spinal anaesthesia were excluded. To reduce bias, the Anaesthetist, rather than Surgeon, decided the choice of analgesia based on personal skill. Efficacy regarding analgesia were collected by nursing staff as patient-reported pain severity (mild, moderate or severe). Data were collected from patient case notes and electronic records. This study analysed analgesia efficacy, complications, inotrope use, and intensive treatment unit (ITU) stay. Results A total of 40 included in the study. Twenty-two patients had TEA (45% female, median age 68 years) and 18 had IPA (44% female, median age 67 years). Median Charleson Comorbidity Index (CCI) was 5 for both. Patient-reported pain was not statistically different (p = 0.15). We noted more analgesia complications with TEA (not working=4, leakage=2, haemodynamic instability=1, lower limb anaesthesia=1) than IPA (leakage=1; p = 0.027). Eleven (50%) TEA and eight (44%) IPA patients required inotropes. TEA patients required significantly longer duration (median duration 35 VS 18 hours, p = 0.047). Median ITU stay was 3 and 2 days for TEA and IPA patients, respectively. Conclusions Both TEA and IPA provide adequate pain relief for KWPD performed via a ‘reversed L’ incision. However, evidence suggests TEA was associated with significantly more analgesia-related complications and longer inotropic requirements. Furthermore, there was also a trend towards ITU stays with TEA. Therefore, we would recommend the use of inter-pleural analgesia over thoracic epidural.

scholarly journals A multicentre, prospective, observational cohort study of variation in practice in perioperative analgesia strategies in elective laparoscopic colorectal surgery (the LapCoGesic study)

2020 ◽  
Vol 102 (1) ◽  
pp. 28-35
Author(s):  
L Brown ◽  
M Gray ◽  
B Griffiths ◽  
M Jones ◽  
A Madhavan ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Colorectal Surgery ◽  
Outcome Measure ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Patient Controlled Analgesia ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Patient Reported ◽  
Observational Cohort

Introduction Enhanced recovery programmes are established as an essential part of laparoscopic colorectal surgery. Optimal pain management is central to the success of an enhanced recovery programme and is acknowledged to be an important patient reported outcome measure. A variety of analgesia strategies are employed in elective laparoscopic colorectal surgery ranging from patient-controlled analgesia to local anaesthetic wound infiltration catheters. However, there is little evidence regarding the optimal analgesia strategy in this cohort of patients. The LapCoGesic study aimed to explore differences in analgesia strategies employed for patients undergoing elective laparoscopic colorectal surgery and to assess whether this variation in practice has an impact on patient-reported and clinical outcomes. Materials and methods A prospective, multicentre, observational cohort study of consecutive patients undergoing elective laparoscopic colorectal resection was undertaken over a two-month period. The primary outcome measure was postoperative pain scores at 24 hours. Data analysis was conducted using SPSS version 22. Results A total of 103 patients undergoing elective laparoscopic colorectal surgery were included in the study. Thoracic epidural was used in 4 (3.9%) patients, spinal diamorphine in 56 (54.4%) patients and patient-controlled analgesia in 77 (74.8%) patients. The use of thoracic epidural and spinal diamorphine were associated with lower pain scores on day 1 postoperatively (P < 0.05). The use of patient-controlled analgesia was associated with significantly higher postoperative pain scores and pain severity. Discussion Postoperative pain is managed in a variable manner in patients undergoing elective colorectal surgery, which has an impact on patient reported outcomes of pain scores and pain severity.

scholarly journals Clinical outcome of the off-pump coronary artery bypass surgery- a comparison between combined high thoracic epidural anaesthesia with GA and GA alone

2014 ◽  
Vol 22 (2) ◽  
pp. 54-60
Author(s):  
Saiful Islam Azad ◽  
Abdul Khaleque Beg ◽  
AYF Elahi Chowdhury ◽  
IH Shahera Khatun
Keyword(s):  
Epidural Anaesthesia ◽  
Off Pump ◽  
Thoracic Epidural ◽  
Thoracic Epidural Anaesthesia ◽  
Arterial Blood ◽  
Post Operative Pain ◽  
Group A ◽  
The Mean ◽  
High Thoracic Epidural ◽  
Group B

Background: The common challenges for the cardiac anaesthesiologist during off pump coronary artery surgery (OPCAB) include haemodynamic stability during the different stressful surgical events and multiple cardiac manipulations, providing adequate myocardial protection, and obtaining effective postoperative analgesia leading to early discharge from the intensive care unit. Objective: This study has been undertaken with a view to find out whether a combined high thoracic epidural anaesthesia (HTEA) with general anaesthesia (GA) is safe and more efficient in providing overall cardiovascular stability as well as improving the parameters leading to a better outcome in terms of a shorter and more predictable road maps to recovery. Methods: Sixty patients aged within 40-70 years, without having any coagulopathy disorder, any emergency surgery or left main disease scheduled for CABG on beating heart were enrolled in prospective, randomized observational comparative study. Patients were divided in two groups. In group A patients received GA alone and in group B patients received high thoracic epidural anaesthesia with GA. The parameters including heart rate, SPO2, CVP, arterial blood pressure, ECG, and ABG analysis were recorded before induction, during induction, intubation and during different events of the surgery. Post operative pain score, sedation score, ventilator hour, duration in the ICU stay,  rescue analgesic need and post operative complications was assessed and recorded. Results: significant per-operative mean heart rate changes were observed all the events except at wound closure and during anastomosis with D1/D2 and the mean difference of mean arterial pressure at intubations, skin incision, sternotomy, pericardiotomy, during anastomosis of distal end of the graft with RCA, PDA, LCX and D1/D2 were observed statistically significant (p<0.05). No incidence of different arrhythmia occurred in group B, premature ventricular complex (PVC) was statistically significant (p<0.05) between two groups. No significant change was found in per-operative pH of arterial blood, PaCO2 and PaO2 changes at different times. Post operative pain score (VAS 0-100) in different time interval was found significant (p<0.05) change between two groups in all follow-up times. Status of rescue analgesics were observed statistically significant (p<0.05). The mean ventilator hours were 7.4±1.09 hours in group A and 5.3±0.81 hours in group B. The mean ICU stay was 72.9±9.2 hours in group A and 57.1±12.0 hours in group B. No post-operative complication was observed in both groups. The data were compiled and analyzed by using statistical software SPSS (ver. 12.0) and significance test performed by unpaired t test and Chi square test. P value <0.05 was considered as statistically significant. Conclusion: Both anaesthetic techniques are equally safe but better clinical outcome of the OPCAB surgery with the high thoracic epidural anaesthesia with GA. DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18142 Journal of BSA, 2009; 22(2): 54-60

scholarly journals A comparative study of efficacy of epidural versus interpleural bupivacaine for post operative analgesia after open cholecystectomy

2014 ◽  
Vol 9 (4) ◽  
pp. 15-23
Author(s):  
RK Yadav ◽  
PC Majhi
Keyword(s):  
Pain Relief ◽  
Open Cholecystectomy ◽  
Fixed Time ◽  
Medical Sciences ◽  
Time Intervals ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Clinically Significant ◽  
Made In

Background The conventional methods of administering the prescribed doses of intramuscular or intravenous analgesics at fixed time intervals results in widely fluctuating and inadequate plasma level leads to poor post operative pain relief. Despite all advances made in the field of medicine, this symptom called “Pain” has not been combated well. Objective The present study was carried out to compare the efficacy of epidural verses interpleural administration of bupivacaine(0.5%) with adrenaline for post operative pain relieve in patients undergoing open cholecystectomy. Methods We prospectively randomized and compared the post operative pain relieve with the reference of visual analog score (VAS) in patients undergoing elective open cholecystectomy in college of medical sciences-teaching hospital, Bharatpur, Chitwan. Forty adult patients undergoing elective cholecystectomy were divided into two groups. Twenty patients in each group were subjected to a different technique of post-operative analgesia, namely thoracic epidural and interpleural instillation of 0.5% bupivacaine. These two groups were then compared in relation to changes produced in the pain scores, vital parameters and complication and side effects associated with the two techniques. The study was conducted for 24 hour postoperatively. Observation: Both thoracic epidural and interpleural instillation of 0.5% bupivacaine compared favorably with regard to analgesia in the present study. In general, the pain relief following thoracic epidural was more complete compared to interpleural but this was not clinically significant. Conclusion The present study shows that both the techniques are equally effective in providing analgesia following cholecystectomy. However, neither technique rendered the patients completely pain free at all times during first 24 hours. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 15-23 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10232

Validation of the prescription drug monitoring program Web site

2019 ◽  
Vol 15 (6) ◽  
pp. 495-498 ◽  
Author(s):  
Bryan A. Hozack, MD ◽  
Michael Rivlin, MD ◽  
Jack Graham, BS ◽  
Kevin F. Lutsky, MD ◽  
Pedro K. Beredjiklian, MD
Keyword(s):  
Prescription Drug ◽  
Upper Extremity ◽  
Drug Monitoring ◽  
Web Site ◽  
Outcome Measure ◽  
Monitoring Program ◽  
Database Search ◽  
Post Operative Pain ◽  
Patient Reported ◽  
Prescription Drug Monitoring Program

Objective: Evaluate the accuracy of the Pennsylvania Prescription Drug Monitoring Program (PA PDMP) in patients undergoing upper extremity procedures. The authors hypothesized that the PA PDMP would provide an accurate account of the prescriptions that were filled.Design: The authors prospectively collected post-operative pain prescription information of patients undergoing outpatient upper extremity surgery over a 2-week period. Patient-reported prescription-filling of opioid was cross-referenced with the PA PDMP information.Setting: The study was performed at one private institution.Patients: One hundred and thirty-nine consecutive patients undergoing upper extremity procedures.Main outcome measure(s): The PA PDMP information was cross-referenced with the post-operative prescription in the medical record to confirm the patient filled the surgeon’s prescription.Results: Of the 111 patients who reported filling their prescription, 107 (96.4 percent) of these were confirmed on the PA PDMP Web site (96.4 percent sensitivity; 95% confidence interval [CI]: 91.0-99.0 percent). None of 28 patients who did not fill their prescription appeared in the database search, resulting in 100 percent specificity (95% CI: 87.7-100 percent). Consequently, the overall accuracy of the PA PDMP was shown to be 97.1 percent (95% CI: 92.8-99.2 percent).Conclusions: The authors’ results suggest that the PA PDMP and its many supplementary databases are accurate as it relates to monitoring opioid prescriptions.

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