Thoracic Epidural Analgesia and Mortality in Acute Pancreatitis

2018 ◽  
Vol 46 (3) ◽  
pp. e198-e205 ◽  
Author(s):  
Matthieu Jabaudon ◽  
Nouria Belhadj-Tahar ◽  
Thomas Rimmelé ◽  
Olivier Joannes-Boyau ◽  
Stéphanie Bulyez ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Epidural Analgesia ◽  
Thoracic Epidural Analgesia ◽  
Thoracic Epidural

Thoracic Epidural Analgesia Augments Ileal Mucosal Capillary Perfusion and Improves Survival in Severe Acute Pancreatitis in Rats

2006 ◽  
Vol 105 (2) ◽  
pp. 354-359 ◽  
Author(s):  
Hendrik Freise ◽  
Stefan Lauer ◽  
Soeren Anthonsen ◽  
Verena Hlouschek ◽  
Evgeny Minin ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Blood Flow ◽  
Inflammatory Response ◽  
Epidural Analgesia ◽  
Thoracic Epidural Analgesia ◽  
Capillary Perfusion ◽  
Treatment Groups ◽  
Thoracic Epidural ◽  
Mucosal Perfusion ◽  
Continuous Perfusion

Background Acute pancreatitis has been linked to intestinal barrier dysfunction and systemic inflammatory response with high mortality. Thoracic epidural analgesia improves intestinal perfusion. The authors hypothesized that thoracic epidural analgesia influences microcirculation injury, inflammatory response, and outcome of acute pancreatitis in rats. Methods Control groups underwent a sham procedure or untreated pancreatitis induced by intraductal taurocholate injection. In the treatment groups, epidural analgesia was commenced immediately or after a 7-h delay. Fifteen hours after injury, the ileal mucosal perfusion was assessed by intravital microscopy. Thereby, the intercapillary area between all perfused capillaries and between continuously perfused capillaries only was used to differentially quantify total and continuous capillary mucosal perfusion. Villus blood flow and serum levels of amylase, lactate, and interleukin 6 were determined, and pancreatic injury was scored histologically. Seven-day survival was recorded in an additional 30 rats undergoing untreated pancreatitis or pancreatitis with epidural analgesia. Results In untreated pancreatitis, decreased total capillary perfusion increased the total intercapillary area by 24%. Furthermore, loss of continuous perfusion increased continuous intercapillary area to 228%. After immediate and delayed epidural analgesia, continuous perfusion was restored (P < 0.05). Blood flow decreased 50% in untreated pancreatitis but was preserved by epidural analgesia (P < 0.05). Biochemical and histologic signs of pancreatitis were not affected by epidural analgesia. Lactate and interleukin-6 levels increased in untreated pancreatitis, which was prevented in the treatment groups (P < 0.05). Epidural analgesia increased 7-day survival from 33% to 73% (P < 0.05). Conclusion Thoracic epidural analgesia attenuated systemic response and improved survival in severe acute pancreatitis. These effects might be explained by improved mucosal perfusion.

scholarly journals Thoracic epidural analgesia: a new approach for the treatment of acute pancreatitis?

Critical Care ◽  
2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Olivier Windisch ◽  
Claudia-Paula Heidegger ◽  
Raphaël Giraud ◽  
Philippe Morel ◽  
Léo Bühler
Keyword(s):  
Acute Pancreatitis ◽  
Epidural Analgesia ◽  
Thoracic Epidural Analgesia ◽  
New Approach ◽  
Thoracic Epidural

scholarly journals PREVENTION OF POST-ERCP PANCREATITIS IN HIGH-RISK PATIENTS

2021 ◽  
Vol 11 (2) ◽  
pp. 72-77
Author(s):  
Mikhail Turovets ◽  
Alexander Popov ◽  
Viktor Mandrikov ◽  
Yury Vedenin ◽  
Andrej Ekstrem
Keyword(s):  
Acute Pancreatitis ◽  
High Risk ◽  
Epidural Analgesia ◽  
Randomized Study ◽  
Opioid Analgesics ◽  
Thoracic Epidural Analgesia ◽  
High Risk Patients ◽  
Thoracic Epidural ◽  
Risk Patients ◽  
Group Post

Aim. To study the efficacy of thoracic epidural analgesia (TEA) for the prevention of post-ERCP pancreatitis in high-risk patients. Materials and methods. A parallel, blinded, randomized study. The first (TEA group) group included patients (n = 98) in whom thoracic epidural analgesia was used during endoscopic transpapillary interventions (ETI), the second (OAI group) group included patients (n = 97) in whom opioid analgesics and indomethacin (per rectum). Results. The study showed that acute pancreatitis was diagnosed significantly less frequently in patients with the TEA group than in patients with the OAI group (p = 0.0135). If in the TEA group post-ERCP pancreatitis (PEP) was verified in 3.1% (3/98) patients, in the OAI group — in 12.4% (12/97) patients. When TEA was used in high risk patients of developing post-ERCP pancreatitis, its incidence decreased from 23.3% (10/43) to 4.4% (2/46) observations (p = 0.0095). Conclusion. The use of TEA is an effective and justified method of prevention in patients at high risk of developing post-ERCP pancreatitis. In patients with a low risk of developing this complication, the use of TEA is inappropriate due to the invasiveness of the method.

Paravertebral Block versus Thoracic Epidural Analgesia for Postthoracotomy Pain Relief: A Meta-Analysis of Randomized Trials

2021 ◽  
Author(s):  
Mu Xu ◽  
Jiajia Hu ◽  
Jianqin Yan ◽  
Hong Yan ◽  
Chengliang Zhang
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Meta Analysis ◽  
Thoracic Epidural Analgesia ◽  
Paravertebral Block ◽  
Cochrane Library ◽  
Thoracic Epidural ◽  
Analgesic Consumption ◽  
Postthoracotomy Pain

Abstract Objective Paravertebral block (PVB) and thoracic epidural analgesia (TEA) are commonly used for postthoracotomy pain management. The purpose of this research is to evaluate the effects of TEA versus PVB for postthoracotomy pain relief. Methods A systematic literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library (last performed on August 2020) to identify randomized controlled trials comparing PVB and TEA for thoracotomy. The rest and dynamic visual analog scale (VAS) scores, rescue analgesic consumption, the incidences of side effects were pooled. Results Sixteen trials involving 1,000 patients were included in this meta-analysis. The pooled results showed that the rest and dynamic VAS at 12, 24, and rest VAS at 48 hours were similar between PVB and TEA groups. The rescue analgesic consumption (weighted mean differences: 3.81; 95% confidence interval [CI]: 0.982–6.638, p < 0.01) and the incidence of rescue analgesia (relative risk [RR]: 1.963; 95% CI: 1.336–2.884, p < 0.01) were less in TEA group. However, the incidence of hypotension (RR: 0.228; 95% CI: 0.137–0.380, p < 0.001), urinary retention (RR: 0.392; 95% CI: 0.198–0.776, p < 0.01), and vomiting (RR: 0.665; 95% CI: 0.451–0.981, p < 0.05) was less in PVB group. Conclusion For thoracotomy, PVB may provide no superior analgesia compared with TEA but PVB can reduce side effects. Thus, individualized treatment is recommended. Further study is still necessary to determine which concentration of local anesthetics can be used for PVB and can provide equal analgesic efficiency to TEA.

scholarly journals Thoracic epidural analgesia improves lung function in CABG patients

2005 ◽  
Vol 52 (S1) ◽  
pp. A48-A48 ◽  
Author(s):  
Paul K. Tenenbein ◽  
Doug Maguire ◽  
Roland Debrouwere ◽  
Peter C. Duke ◽  
Stephen E. Kowalski
Keyword(s):  
Lung Function ◽  
Epidural Analgesia ◽  
Thoracic Epidural Analgesia ◽  
Thoracic Epidural ◽  
Cabg Patients
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