Efficacy of Postoperative Patient-controlled and Continuous Infusion Epidural Analgesia versus  Intravenous Patient-controlled Analgesia with Opioids

2005 ◽  
Vol 103 (5) ◽  
pp. 1079-1088 ◽  
Author(s):  
Christopher L. Wu ◽  
Seth R. Cohen ◽  
Jeffrey M. Richman ◽  
Andrew J. Rowlingson ◽  
Genevieve E. Courpas ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Meta Analysis ◽  
Epidural Infusion ◽  
Patient Controlled Analgesia ◽  
Analgesic Agent ◽  
Postoperative Patient ◽  
Continuous Epidural Infusion ◽  
Pain At Rest

The authors performed a meta-analysis and found that epidural analgesia overall provided superior postoperative analgesia compared with intravenous patient-controlled analgesia. For all types of surgery and pain assessments, all forms of epidural analgesia (both continuous epidural infusion and patient-controlled epidural analgesia) provided significantly superior postoperative analgesia compared with intravenous patient-controlled analgesia, with the exception of hydrophilic opioid-only epidural regimens. Continuous epidural infusion provided statistically significantly superior analgesia versus patient-controlled epidural analgesia for overall pain, pain at rest, and pain with activity; however, patients receiving continuous epidural infusion had a significantly higher incidence of nausea-vomiting and motor block but lower incidence of pruritus. In summary, almost without exception, epidural analgesia, regardless of analgesic agent, epidural regimen, and type and time of pain assessment, provided superior postoperative analgesia compared to intravenous patient-controlled analgesia.

Patient-Controlled Epidural Analgesia Versus Continuous Epidural Infusion with Ropivacaine for Postoperative Analgesia in Children

2003 ◽  
Vol 97 (6) ◽  
pp. 1608-1611 ◽  
Author(s):  
Emmanuel Antok ◽  
Fabienne Bordet ◽  
Frédéric Duflo ◽  
Sabine Lansiaux ◽  
Sylvie Combet ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Postoperative Analgesia ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion

Postoperative Analgesia with No Motor Block by Continuous Epidural Infusion of Ropivacaine 0.1% and Sufentanil After Total Hip Replacement

1999 ◽  
Vol 89 (2) ◽  
pp. 395-398 ◽  
Author(s):  
Sandra Kampe ◽  
Christoph Weigand ◽  
Jost Kaufmann ◽  
Markus Klimek ◽  
Dietmar Pierre Konig ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Postoperative Analgesia ◽  
Hip Replacement ◽  
Motor Block ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion ◽  
Total Hip

Postoperative Analgesia with No Motor Block by Continuous Epidural Infusion of Ropivacaine 0.1% and Sufentanil After Total Hip Replacement

1999 ◽  
Vol 89 (2) ◽  
pp. 395-398 ◽  
Author(s):  
Sandra Kampe ◽  
Christoph Weigand ◽  
Jost Kaufmann ◽  
Markus Klimek ◽  
Dietmar Pierre Konig ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Postoperative Analgesia ◽  
Hip Replacement ◽  
Motor Block ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion ◽  
Total Hip

scholarly journals Controlo de Dor, Infeção Local, Satisfação, Efeitos Adversos e Dor Residual no Pós-Operatório de Cirurgia Abdominal Major: Epidural versus Infusão Contínua da Ferida Cirúrgica (PAMA Trial)

2017 ◽  
Vol 30 (10) ◽  
pp. 683 ◽  
Author(s):  
Rita Araújo ◽  
Céline Marques ◽  
David Fernandes ◽  
Emanuel Almeida ◽  
Joana Alves ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Epidural Analgesia ◽  
Postoperative Analgesia ◽  
Standard Technique ◽  
Hemodynamic Instability ◽  
Pain Scale ◽  
Major Abdominal Surgery ◽  
Continuous Epidural Infusion ◽  
Infusion Group

Introduction: The Management of postoperative pain after abdominal surgery is a major challenge to the anesthesiologist. The optimization of postoperative analgesia improves prognosis contributing also to patient satisfaction and reducing morbidity and mortality. The aim of this randomized control study is to perform the comparative analysis in terms of effectiveness of an unconventional and still poorly technique implemented, continuous wound infusion, and the currently most applied and gold standard technique, epidural analgesia, in the postoperative period after abdominal surgery.Material and Methods: Fifty patients, previously subjected to abdominal surgery by median laparotomy with xifo-pubic incision were randomized to receive postoperative analgesia via epidural (n = 25) or via continuous wound infusion (n = 25) during 48 hours. The primary outcome was analysis of pain at rest (< 4/10 numerical pain scale) after 24 hours postoperatively. Scores of pain at six, 12 and 48 hours and three months after surgery were also evaluated, as well as the incidence of adverse effects 48 hours postoperatively.Results: The proportion of patients with successful control of postoperative pain was 84% against 60% with epidural analgesia and continuous wound infusion, respectively. Within the continuous wound infusion group with uncontrolled pain, all patients rated the pain below 6/10 24 hours postoperatively. The incidence of nausea, vomiting, pruritus or íleus was lower in the continuous wound infusion group, with statistically significant results for recovery of intestinal function. There was one case of systemic local anesthetic toxicity with an episode of frequent ventricular extrasystoles without hemodynamic instability, which ceased after suspension of continuous epidural infusion of local anesthetic.Discussion: This study suggests that continuous wound infusion is the technique with most efficacy and safety, being even better than epidural analgesia in postoperative pain control after major abdominal surgery. This technique is associated with better analgesia, lower incidence of side effects, high level of satisfaction and no residual pain, contributing to enhanced recovery.Conclusion: Continuous wound infusion is an effective technique, which should be implemented for analgesia after major abdominal surgery, with advantages when compared with epidural analgesia, especially low incidence of adverse effects.Registration: Trial not registered.

scholarly journals Perineural Dexamethasone Added to Local Anesthesia for Brachial Plexus Block Improves Pain but Delays Block Onset and Motor Blockade Recovery

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. 1-14
Author(s):  
Kenneth D. Candido
Keyword(s):  
Postoperative Pain ◽  
Brachial Plexus ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Meta Analysis ◽  
Pain Scores ◽  
Central Registry ◽  
Plexus Block ◽  
Higher Doses

Background: Multiple studies have shown that perineural dexamethasone improves postoperative analgesia. However, some studies have shown minimal benefit, and have raised concerns regarding adverse physio-chemical effects of perineural dexamethasone. Furthermore, there is a paucity of studies wherein control (IV) dexamethasone was considered. Objective: The purpose of this meta-analysis was to evaluate the effectiveness of different concentrations of perineural dexamethasone injection on postoperative analgesia, as well as complications from its use for brachial plexus blocks. Methods: A systematic literature search was conducted using the Cochrane Central Registry of Controlled Trials, PubMed, and Scopus. Trials comparing control and local dexamethasonetreated groups, and those which reported duration of analgesia and/or pain scores/opioid consumptions were selected. Meta-analysis was performed using the Review Manager (RevMan) software 5.1. Results: Fourteen studies consisting of a total of 1,022 patients were included. Perineural dexamethasone significantly prolonged the duration of postoperative analgesia in patients receiving both low-dose (4 – 5 mg) [SMD 2.41 (95% CI: 1.47, 3.35 P = 0<0.00001) I2 = 82%], and higher-doses (8 – 10 mg) [SMD 4.46 (95% CI 3.54, 5.38 P < 0.00001) I2 = 94%]. However, the duration of motor block was also prolonged [SMD 2.52 (95% CI: 1.06, 3.98 P = 0.0007) I2 = 97%] and dexamethasone delayed latency of onset of sensory [SMD -0.49 (95% CI: -0.89, -0.09 P = 0.02) I2 = 76%] and motor [SMD -0.56 (95% CI: -1.13, 0.00 P = 0.05) I2 = 87%] blocks. Postoperative pain scores were improved at both 24 hours [SMD -1.46 (95% CI: -2.43, -0.50 P = 0.003) I2 = 95%] and 48 hours [SMD -1.20 (95% CI: -2.26, -0.13 P = 0.03) I2 = 95%] in dexamethasone-treated groups, whereas opioid consumption was reduced only at 48 hours [SMD -2.97 (95% CI: -4.17, -1.76 P < 0.00001) I2 = 88%]. Complications were comparable between control and dexamethasone-adjuvant groups, except for the excessively prolonged nerve block that was observed predominantly in the dexamethasone-adjuvant group. Limitations: The limitations include different definitions used for the measurements of certain parameters such as the duration of analgesia and duration of motor block, number of studies assessing certain parameters having high heterogeneity, and varying types of local anesthetics used in various studies. Conclusions: Perineural dexamethasone addition to local anesthetic solutions significantly improved postoperative pain in brachial plexus block without increasing complications. However, perineural adjuvant dexamethasone delayed the onset of sensory and motor block, and prolonged the duration of motor block. Smaller doses of dexamethasone (4 – 5 mg) were as effective as higher doses (8 – 10 mg). Key words: Dexamethasone, perineural, brachial plexus block, postoperative pain, metaanalysis, systematic review

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