scholarly journals Incidence of Epidural Catheter-associated Infections after Continuous Epidural Analgesia in Children

2010 ◽  
Vol 113 (1) ◽  
pp. 224-232 ◽  
Author(s):  
Navil F. Sethna ◽  
David Clendenin ◽  
Umeshkumar Athiraman ◽  
Jean Solodiuk ◽  
Diana P. Rodriguez ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Epidural Catheter ◽  
Medical Decision ◽  
Incidence Data ◽  
Serious Infections ◽  
Continuous Epidural Analgesia ◽  
Pediatric Populations ◽  
Epidural Catheters

Clinical observation suggests that the number of serious epidural catheter-associated infections have increased recently in children. This increase is likely attributed to an increase in reporting and in frequency of epidural analgesia usage. Estimates of infection rates are difficult to determine primarily because of insufficient study of large pediatric populations. In this retrospective study, the authors investigated the incidence of epidural catheter-associated soft tissue and epidural infections after use of continuous epidural analgesia spanning 17 yr. A total of 10,653 epidural catheters were used in 7,792 children. The majority of catheters, 10,437 (98%), were placed for the management of postoperative pain, and 216 (2%) were placed for the management of chronic pain. The authors identified 13 cases of infections (nine cellulitis, two paravertebral musculature infections, one epidural inflammation, and one epidural abscess) between 3 and 11 days after catheter insertion. The incidence of infection was significantly higher in patients treated for chronic pain (7 of 216 = 3.2%) compared with postoperative pain (6 of 10,437 = 0.06%; P < 0.0001). Surgical drainage of subcutaneous pus was performed in three patients, and medical therapy was administered in the remainder of patients; all patients recovered without sequelae. Although rare, epidural catheter-associated infections remain a serious concern in high-risk children who may benefit the most from epidural analgesia. The findings of the authors support the low rate of epidural infection previously reported despite growing concerns of serious infections in children. These findings highlight the importance of vigilance to early diagnostic indicators of infection and provide practitioners and families with incidence data to guide informed medical decision-making.

Epidural Analgesia in the Management of Severe Vaso-Occlusive Sickle Cell Crisis

PEDIATRICS ◽  
1994 ◽  
Vol 93 (2) ◽  
pp. 310-315 ◽  
Author(s):  
Myron Yaster ◽  
Joseph R. Tobin ◽  
Carol Billett ◽  
James F. Casella ◽  
George Dover
Keyword(s):  
Epidural Analgesia ◽  
Oxygen Saturation ◽  
Epidural Catheter ◽  
Respiratory Depression ◽  
Sickle Cell ◽  
Local Anesthetic ◽  
Analgesic Therapy ◽  
Plasma Lidocaine ◽  
Continuous Epidural Analgesia ◽  
Epidural Catheters

Objectives. To determine whether continuous epidural analgesia could effectively decrease pain and thereby improve the management of severe vaso-occlusive crisis in children with sickle cell disease who were unresponsive to conventional analgesic therapy. Design. Retrospective observational study. Setting. A tertiary care hospital with a large pediatric sickle cell patient referral population. Patients. The study describes nine children in 11 painful vaso-occlusive crises, unresponsive to high-dose systemic opioids, nonsteroidal anti-inflammatory drugs, and adjunctive measures, who underwent continuous epidural analgesia to control pain. Outcome Measures. Subjective pain scores, arterial oxygen saturation monitoring, and plasma lidocaine levels. Methods. Placement of an epidural catheter for the administration of a continuous infusion of local anesthetic, alone, or in combination with fentanyl, in the management of vaso-occlusive crisis. Results. At initiation of epidural analgesic therapy, 8 of 9 patients reported severe pain (8 to 10 on a scale of 0 to 10, 0 = no pain, 10 = the worst pain they ever experienced). Analgesia was immediate (pain score 0 to 2) in 8 of 9 patients, and continuously effective in 9 of 11 crises. Five patients required either the addition of fentanyl or changing the local anesthetic from lidocaine to bupivacaine to maintain analgesia for 2 to 5 days. In 7 of 9 patients, oxygen saturation dramatically increased from 87 to 95% to 99 to 100% after epidural analgesia was initiated. In all patients, plasma lidocaine levels ranged from 1.1 to 4.6 mg/L and dose-related toxicity did not occur. One patient developed hypotension secondary to high sympathetic blockade (T-4), one had an inadvertent dural puncture during insertion of the catheter, one had the epidural catheter removed for fever, and one achieved analgesia only transiently. There were no other complications, and epidural analgesia was not associated with sedation, respiratory depression, or limitation of movement. All epidural catheters were cultured on removal, and colonization did not occur. Conclusions. Epidural analgesia with local anesthetics administered alone or in combination with fentanyl effectively and safely treats the pain of sickle cell vaso-occlusive crisis unresponsive to conventional pain management and does so without causing sedation, respiratory depression, or significant limitation on ambulation. Furthermore, early treatment of painful crisis with this technique may improve oxygenation, a critical factor in the evolution of further sickling.

scholarly journals Tumour Metastasis at the Site of a Previous Epidural Catheter

2008 ◽  
Vol 36 (6) ◽  
pp. 863-866
Author(s):  
M. M. Chappell ◽  
H. A. Schoengen
Keyword(s):  
Bladder Cancer ◽  
Case Report ◽  
Epidural Analgesia ◽  
Epidural Catheter ◽  
Radical Cystectomy ◽  
Emergency Surgery ◽  
Vertebral Level ◽  
Tumour Metastasis ◽  
Continuous Epidural Analgesia ◽  
Epidural Catheters

Epidural catheters can cause a number of rare, serious complications. The following case report describes a patient who received continuous epidural analgesia following radical cystectomy for bladder cancer. Fifty-three days after the cystectomy, the patient underwent emergency surgery for a metastasis at the vertebral level where the epidural catheter had been inserted. A metastasis at the site of an epidural catheter, which may be a direct complication of epidural analgesia, is a previously unreported event. Local, anatomical and pathological factors which may have led to the patient developing a metastasis at the epidural site are discussed.

Continuous Femoral Nerve Blockade versus Continuous Epidural Analgesia for Postoperative Pain Relief in Knee Surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hala Gomaa Salama ◽  
Ahmed Ali El- Shebiny ◽  
Abd Al Aziz Abdullah Abd Al Aziz ◽  
Mariam Mahmoud Ahmed Ali Shehata
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Weight Bearing ◽  
Femoral Nerve ◽  
Disease Process ◽  
Continuous Epidural Analgesia ◽  
Significant Difference ◽  
Continuous Femoral Nerve Block

Abstract Background The progression of osteoarthritis is characteristically slow, occurring over several years or decades. Over this period, the patient can become less and less active and thus more susceptible to morbidities related to decreasing physical activity (including potential weight gain). Early in the disease process, the joints may appear normal. However, the patient’s gait may be antalgic if weight-bearing joints are involved. Objective Compare the benefits of continuous femoral nerve block (CFNB) with those of continuous epidural analgesia CEPA for postoperative pain management after Knee surgeries. Methods This study is a randomized controlled clinical trial was conducted in Ain Shams University Hospitals after obtaining approval from the Research Ethical Committee of Ain Shams University during a period of three months. Patients undergoing primary unilateral TKA for osteoarthritis, were recruited at least one day prior to the scheduled surgery, male and female patients. Results There was significant difference in terms of pain scoring between continuous femoral nerve block (CFNB) and continuous epidural analgesia (CEA) in the first 6 hours, 12 hours, 24 hours, 48 hours, 72 hours but non significant difference in incidence of side effects Conclusion Our study showed that CEA had optimal analgesia and pain control than CFNB in management of post operative pain after total knee replacement.

scholarly journals EFFECT OF POSTOPERATIVE EPIDURAL ANALGESIA AFTER MAJOR ORTHOPEDIC SURGERIES, A 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   

Clinical and Bacteriologic Survey of Epidural Analgesia in Patients in the Intensive Care Unit

1996 ◽  
Vol 85 (5) ◽  
pp. 988-998 ◽  
Author(s):  
Bruno Darchy ◽  
Xavier Forceville ◽  
Eric Bavoux ◽  
Frederic Soriot ◽  
Yves Domart
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Epidural Analgesia ◽  
Epidural Catheter ◽  
Strong Predictor ◽  
Insertion Site ◽  
Space Infection ◽  
General Signs ◽  
Epidural Catheters

Background The risk of bacterial contamination related to epidural analgesia in patients cared for in the intensive care unit has not been assessed. Thus the authors studied patients who received care in the intensive care unit who were given epidural analgesia for more than 48 h to determine the rates of local, epidural catheter, and spinal space infection and to identify risk factors. Methods Each patient receiving epidural analgesia for longer than 48 h was examined daily for local and general signs of infection. A swab sample for culture was taken if there was local discharge; all epidural catheters were cultured on withdrawal. All patients underwent weekly neurologic monitoring for 1 month; those with positive epidural catheter cultures had one spinal magnetic resonance image scan. Results The 75 patients cared for in the intensive care unit who were studied had been receiving epidural analgesia for a median of 4 days (interquartile range, 3.5 to 5 days). Twenty-seven patients had signs of local inflammation (erythema or local discharge), and nine of these had infections. All the patients who had both local signs also had infection. All nine infections were local (12%), but four patients also had epidural catheter infections (5.3%). No patient with erythema alone or without local signs had a positive epidural catheter culture. No spinal space infection was diagnosed. Staphylococcus epidermidis was the most frequently cultured microorganism. Local infection was treated by removing the epidural catheter without any antibiotics. Concomitant infection at other sites (21 of 75 patients, or 28%), antibiotic therapy (64 of 75 patients, or 85%), the duration of epidural analgesia, and the insertion site level of the epidural catheter were not identified as risk factors for epidural analgesia-related infections. Conclusions The risk of epidural analgesia-related infection in patients in the intensive care unit seems to be low. The presence of two local signs of inflammation is a strong predictor of local and epidural catheter infection.

Regional anaesthesia of the trunk

2017 ◽  
Author(s):  
Andrew Berrill ◽  
Will Jones ◽  
David Pegg
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Regional Anaesthesia ◽  
Rectus Sheath ◽  
Transversus Abdominis ◽  
Respiratory Morbidity ◽  
Major Surgery ◽  
Analgesic Regimen ◽  
Continuous Epidural Analgesia

Analgesia of the thorax and abdomen can be challenging. Surgical incisions are commonly associated with severe postoperative pain. Whilst continuous epidural analgesia remains the ‘gold standard’ in terms of postoperative pain relief after major surgery, there remain concerns regarding rare serious side effects. It has been difficult to demonstrate conclusive evidence of improvement in outcomes when epidural analgesia is used. Superior pain relief and a reduction in postoperative respiratory morbidity are, however, clear advantages of regional anaesthesia. Interest has increased in techniques such as paravertebral and rectus sheath blocks in part due to the ready availability of high-definition portable ultrasound equipment, but also in response to concerns regarding neuraxial blockade and the development of enhanced recovery pathways. In addition, novel approaches to analgesia of the trunk, such as the transversus abdominis plane block, have been developed and are now widely used as part of a multimodal analgesic regimen. In this chapter, techniques of neuraxial and peripheral nerve block are discussed along with their indications and complications.

scholarly journals Comparison of analgesic efficacy of continuous transversus abdominis plane block with continuous epidural analgesia in patients undergoing abdominal surgery: a systematic review and meta-analysis

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092269
Author(s):  
Xiangbo Liu ◽  
Cehua Ou ◽  
Fei Peng ◽  
Guo Mu
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Epidural Analgesia ◽  
Meta Analysis ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Chinese Patients ◽  
Transversus Abdominis Plane ◽  
Novel Technique ◽  
Continuous Epidural Analgesia

Background A novel technique of continuous transversus abdominis plane block (TAPB) has been reported to be beneficial to patients undergoing abdominal surgery because it can significantly relieve postoperative pain. The aim of our study is to compare this novel technique with a traditional technique of continuous epidural analgesia (EA). Methods We conducted our meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only randomized controlled trials (RCTs) that compared the efficacy of continuous TAPB and continuous EA to relieve postoperative pain were included. Patients were classified by nationality (Chinese, non-Chinese) for the subgroup analysis. Results Nine RCTs with 598 patients were included in our study. Pain levels measured by visual analog scale (VAS) scores at rest on postoperative day 1 were equivalent for continuous TAPB groups and continuous EA groups in non-Chinese and Chinese patients. The TAPB groups experienced a lower rate of hypotension, sensorimotor disorder, and nausea compared with the continuous EA group within 48 hours after surgery. Conclusion Continuous TAPB and continuous EA are equally effective in relieving postoperative pain at rest 24 hours after surgery, but EA was associated with more side effects such as hypotension, nausea, and sensorimotor disorder.

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