Effect of combining epidural with general anesthesia on recovery after spine surgery: randomized controlled study

Background: Fast track techniques have been applied to reduce surgical stress response and to provide effective perioperative analgesia, thereby improving patient''''''''s recovery and reducing postoperative morbidity. The present study was undertaken to assess the effect of using combined general/epidural anesthesia (CGEA) on early recovery after lumbar spine surgeries. Subjects and Methods: The current prospective randomized clinical study had included a total of 40 patients who underwent elective one or two level laminectomy/discectomy. Patients were randomized and divided into two groups; general anesthesia (GA) group (group I) and combined general/epidural anesthesia group (CGEA) (group II). Patient characteristics, anesthesia time, surgical time, heart rate, mean arterial pressure (MAP), anesthetic / analgesic requirements, the occurrence of intraoperative bradycardia and/or hypotension, time to extubation, time to post anesthesia care unit (PACU) discharge and duration of PACU stay were recorded and considered for analysis. Results: It was observed that CGEA was significantly associated with reduction of intraoperative anesthetics / analgesic requirements, shorter time to extubation, time for PACU discharge and duration of PACU stay but on the expense of higher incidence of intraoperative hypotension. Conclusion: This study proved that CGEA seems to be an effective fast track anesthetic protocol in patients undergoing elective lumbar spine surgeries

Studies on Epidural anaesthesia using lidocaine with adrenaline on hemato-biochemical responses in pregnant West African Dwarf goats

Epidural anesthesia is commonly utilized in veterinary medicine to allow diagnostic, obstetrical, and surgical interventions caudal to the umbilicus in the perineal region of large animal. Addition of a vasoconstrictor to a local anesthetic has been shown to have several beneficial effects. This study was carried out to investigate the effects of lidocaine with epinephrine on physiological, haematological and biochemical parameters in pregnant West African dwarf goats. Four healthy pregnant goats were administered with lidocaine combined with epinephrine (4kg/ml) in the lumbosacral epidural space. Physiological parameters were taken at 30minutes intervals while the hematological and biochemical analyses were done hourly for 3 hours. There were decreases in the hematological parameters including Hb, PCV, RBCs, Neutrophil and platelets after epidural analgesia especially at second and third hours post administration. The glucose, sodium ion, potassium ion, chloride ion, bicarbonate ion increased significantly (P<0.05) at the third hour post administration while the urea and creatinine levels did not show any significant change. The heart rate decreased significantly (P<0.05) post administration of drugs when compared with the onset, respiratory rate increased while the rectal temperature showed a non-significant change. In conclusion, the combination of epinephrine and lidocaine solution for epidural anaesthesia provided a prolonged duration of action without any serious adverse effects in pregnant goats

Thoracic epidural for post-thoracotomy pain: a comparison of three concentrations of sufentanil in bupivacaine

ABSTRACT. Background:The aim of this prospective, double blind, randomised trial was to compare the analgesic and adverse effectsof three concentrations of the thoracic epidural sufentanil with bupivacaine in patients undergoing thoracotomy.Methods:We studied 60 (randomised) patients who were to receive a 10 ml bolus dose of sufentanil, 1µg/ml, 2 µg/ml and3 µg/ml, in bupivacaine 0.125%, via thoracic epidural. Postoperatively, pain at rest, on coughing and with ambulation wasassessed using a visual analogue scale (VAS) and observer verbal ranking score (OVRS) at 2, 6, 12 and 24 hours. Adverseeffects were simultaneously assessed.Results:There was no significant difference in the baseline characteristics between the three groups. The number of patientswith episodes of unsatisfactory pain, i.e. a VAS scores ≥ 40 and OVRS ≥ 2, at each of the four assessments postoperatively,was significantly higher with sufentanil 1 g/ml than with sufentanil 2 µg/ml or µ3 g/ml (p < 0.05). In the 3 µg/ml sufentanilgroup, four patients (20%) had a sedation score ≥ 3 compared with one (5%) and no (0%) patients in the 2 µg/ml and1 µg/ml sufentanil groups, respectively (p < 0.05). In addition, 30% patients experienced pruritus in the 3 µg/ml sufentanilgroup compared with 10% and 5%, respectively, in the 2 µg/ml and 1 µg/ml sufentanil groups. In the sufentanil 3 µg/ml,2 µg/ml and 1 µg/ml groups, 30%, 20% and 5% patients, respectively, had emetics symptoms (p < 0.05).Conclusions:We conclude that a thoracic epidural bolus of 10 ml sufentanil 2 µg/ml with bupivacaine 0.125% provides theoptimal balance between pain relief and side-effects following thoracotomy