Faculty Opinions recommendation of Epidural analgesia for pain relief following hip or knee replacement.

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.

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Are paravertebral block and thoracic epidural analgesia comparable for post-thoracotomy pain relief? A systematic review

European Journal of Anaesthesiology ◽

10.1097/00003643-200606001-00418 ◽

2006 ◽

Vol 23 (Supplement 37) ◽

pp. 117

Author(s):

F. Bonnet ◽

G. Joshi ◽

R. Shah

Keyword(s):

Systematic Review ◽

Pain Relief ◽

Epidural Analgesia ◽

Thoracic Epidural Analgesia ◽

Paravertebral Block ◽

Thoracic Epidural

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Acomparative Study between Epidural Analgesia of Levobupivacaine with Fentanyl versus Dexmedetomidine for knee replacement surgeries

QJM ◽

10.1093/qjmed/hcab086.093 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Naglaa Mohammed Ali ◽

Ehab Hamed Abd El Mohsen ◽

Rania Maher Hussien ◽

Omar Abd El Gawad Kamel Massoud

Keyword(s):

Postoperative Pain ◽

Epidural Analgesia ◽

Knee Replacement ◽

Sedation Score ◽

Gamma Aminobutyric Acid ◽

University Hospitals ◽

Research Committee ◽

Duration Of Action ◽

Dose Dependent Decrease ◽

Double Blinded

Abstract Background The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. Epidural analgesia offers superior postoperative pain relief compared with systemic opioids. In addition to improved patient outcome. Objective To compare the effect of dexmedetomidine and fentanyl as an adjuvant to epidural levobupivacaine in knee replacement surgeries regarding duration of action and the analgesic potency of both drugs. Patients and Methods This prospective double blinded randomized clinical trial study was conducted in Maadi Military and Ain Shams University Hospitals after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent knee replacement surgeries were included in the study their ages range between 21 and 60 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization into two groups 30 patients in each (n = 30). Results As regards sedation score intraoperative and postoperative, in the present study, we found that Ramsay sedation score was significantly higher in group ‘BD’ when compared to group ‘BF’ intraoperative and postoperative. This finding may be attributed to the sedative properties of dexmedetomidine that is far superior to fentanyl acting by dose-dependent decrease in activity of noradrenergic neurons in the brain stem via post-synaptic receptor-mediated inhibition. This increases gamma-aminobutyric acid (GABA) neurone activity, which mediates central sedative effects. Conclusion Epidural levobupivacaine with dexmedetomidine provided better sedation, adequate surgical anesthesia with prolonged postoperative analgesia for lower limb surgeries. Both adjuvants reduced the epidural dose of levobupivacaine and potentiated its efficacy.

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Efficacy of Epidural Analgesia for Pain Management of Critically Ill Patients and the Implications for Nursing Care

AACN Advanced Critical Care ◽

10.4037/15597768-1991-4013 ◽

1991 ◽

Vol 2 (4) ◽

pp. 729-740 ◽

Cited By ~ 1

Author(s):

Jeanne F. Slack ◽

Margaret Faut-Callahan

Keyword(s):

Critical Care ◽

Pain Relief ◽

Epidural Analgesia ◽

Critically Ill ◽

Nursing Care ◽

Critically Ill Patients ◽

Continuous Epidural Analgesia ◽

Analgesic Agents ◽

Care Problems ◽

Critical Care Patients

Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient’s recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care

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Pharmacological and Non-Pharmacological Methods of Labour Pain Relief—Establishment of Effectiveness and Comparison

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15122792 ◽

2018 ◽

Vol 15 (12) ◽

pp. 2792 ◽

Cited By ~ 5

Author(s):

Iwona Czech ◽

Piotr Fuchs ◽

Anna Fuchs ◽

Miłosz Lorek ◽

Dominika Tobolska-Lorek ◽

...

Keyword(s):

Pain Relief ◽

Epidural Analgesia ◽

Water Immersion ◽

Labour Pain ◽

Satisfaction Level ◽

Pain Level ◽

Mean Values ◽

Significant Difference ◽

Third Stage ◽

Water Birth

Background: To evaluate the effectiveness of pharmacological and non-pharmacological pain relief methods and to compare them. Materials and methods: 258 women were included in the study and interviewed using a questionnaire and the visual analogue scale for pain. They were divided into six groups depending on chosen method of labour pain relief: epidural anaesthesia (EA; n = 42), water immersion and water birth (WB; n = 40), nitrous oxide gas for pain control (G; n = 40), transcutaneous electrical nerve stimulation (TENS) (n = 50), multiple management (MM; n = 42), none (N; n = 44). Results: The average age of the women was 29.4 ± 3.74 years and 60.47% of them were nulliparous (n = 156). Mean values of labour pain intensity were 6.81 ± 2.26 during the first stage of labour; 7.86 ± 2.06 during the second stage, and 3.22 ± 2.46 during the third stage. There was no significant difference in pain level between epidural analgesia and gas groups in the first stage of labour (p = 0.74). Nevertheless, epidural analgesia reduced pain level during the second and third stage (both p < 0.01). The highest satisfaction level pertains to water immersion (n = 38; 95%). Conclusion: Epidural analgesia is the gold standard of labour pain relief, however water birth was found to be associated with the highest satisfaction level of the parturient women. The contentment of childbirth depends not only on the level of experienced pain, but also on the care provided to the parturient during pregnancy and labour.

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