Catéter epidural roto, una complicación poco frecuente / Broken epidural catheter, a rare complication

Resumen: Actualmente, la anestesia neuroaxial es preferida por sus múltiples ventajas con respecto al manejo del dolor. El procedimiento involucra la colocación de un catéter epidural en el espacio peridural, una complicación muy rara es la ruptura de éste. Se estima una incidencia de 0.002 a 0.004%. El presente trabajo reporta el caso de un paciente masculino de 77 años sometido a una resección transuretral de próstata, que presenta ruptura del catéter durante el retiro. La tomografía reportó la presencia del catéter a nivel subaracnoideo, sin presencia de síntomas en el paciente. Se egresó y a los seis meses de seguimiento no presentaba síntomas. Es de importancia comprender que siempre se debe notificar al paciente en caso de que esto suceda y después realizar estudios de imagen para su localización. Posteriormente se debe valorar la presencia de síntomas y, si existen, considerar una laminectomía para su retiro.

Abstract: Nowadays, neuraxial anesthesia is preferred due to its multiple advantages related to pain management. This procedure involves placing an epidural catheter within the epidural space, with rupture of the catheter being an uncommon complication. Its incidence is around 0.002 to 0.004%. The present work reports the case of a 77-year-old male who underwent a transurethral prostate resection, where the catheter broke while being removed. CT scan reported the presence of the catheter within subarachnoid space, without the patient presenting symptoms. It is important to understand that notifying the patient is a priority in case this complication happens, and then order imaging studies to locate the catheter. Finally, if symptoms are present, a laminectomy should be assessed to remove the remaining piece.

Neurolytic Caudal Epidural Block for Rectal Tenesmus: A Case Report

Rectal tenesmus is a very uncomfortable symptom. Though antiarrhythmic drugs and nerve blocks have been proposed as a treatment for rectal tenesmus, none is well-established. We report a 68-year-old female who undertook surgery for uterine cervical cancer and underwent chemotherapy. She got a bilateral nephrostomy and bowel obstruction during the chemotherapy because of recurrence. She decided to stop chemotherapy and to receive palliative care. She had a symptom of rectal tenesmus, which was refractory to medications. The clinical sign was severe and uncomfortable, making her very nervous. We planned to treat the rectal tenesmus with a nerve block. A ganglion impar block was insufficient to remove the symptom, and the saddle block failed due to epidural lipomatosis. We finally succeeded in alleviating the sign with a neurolytic caudal epidural block. Relief of tenesmus made her hope to spend her final period at home. She could stay at home with her family for seven days before death without recurrence of the symptom. Though there is no report about the effectiveness of neurolytic caudal epidural block for rectal tenesmus, we consider the block appropriate for the symptom.

Schwannoma en el puerperio / Schwannoma in the puerperium

Resumen: Se presenta el caso de una paciente de 48 años, previamente sana, sometida a cesárea bajo bloqueo epidural que presenta datos de compresión medular en el puerperio inmediato. El diagnóstico inicial fue una complicación por anestesia neuroaxial, después de la resonancia magnética se reporta tumor intrarraquídeo a nivel de T9-T10 que fue extirpado con diagnóstico histológico de schwannoma. La evolución postquirúrgica de la paciente fue favorable sin secuelas neurológicas. Los schwannomas son tumores benignos cuya principal manifestación son síntomas de compresión medular.

Abstract: It is presented a case of a 48-year-old patient, previously healthy, who underwent cesarean section under epidural block and presented data of spinal cord compression in the immediate puerperium. The initial diagnosis was a complication due to the neuraxial anesthesia. Afterwards, the MRI reported an intraspinal tumor at the T9-T10 level, which was removed with a histological diagnosis of schwannoma. The patient´s postoperative evolution was favorable, with no neurological sequelae. Schwannomas are benign tumors, whose main manifestation is symptoms of spinal cord compression.

Absceso epidural en una paciente obstétrica / Epidural abscess in an obstetric patient

Resumen: El absceso epidural es una complicación rara que puede ser causa de una elevada morbimortalidad, por ello es fundamental el diagnóstico y tratamiento oportunos. Nuestra paciente desarrolló un absceso posterior a un bloqueo epidural para una cesárea, la técnica anestésica se realizó en condiciones de asepsia y antisepsia, y se retiró el catéter al terminar la cirugía; fue dada de alta a las 48 horas. Reingresa a los nueve días por presentar fiebre, dolor en miembro pélvico izquierdo y dehiscencia de herida quirúrgica. La resonancia magnética mostró un absceso epidural en L3-L4. Se realizó laminectomía y el cultivo mostró Escherichia coli, fue manejada con antibióticos intravenosos durante cuatro semanas y se dio de alta sin secuelas neurológicas.

Abstract. Spinal epidural abscess is a rare complication, it can be cause a high morbimortality and the prompt diagnosis and treatment is essential. Our patient present an abscess after epidural block for caesarean section, the anesthetic procedure was in aseptic technique and the catheter was withdrawn after surgery, the patient was discharged after 48 hours. She was readmitted nine days later with fever, left leg pain and wound surgery infection. The magnetic resonance showed a spinal epidural abscess in L3-L4. Underwent laminectomy cultured showed Escherichia coli, she was at hospital by intravenous antibiotic treatment for 4 weeks and she was discharged without neurologic sequelae.

Comparison between erector spinal plane block and epidural block techniques for postoperative analgesia in open cholecystectomies: a randomized clinical trial / Comparação entre as técnicas de bloqueio do plano do músculo eretor da espinha e bloqueio epidural para analgesia pós-operatória em colecistectomias abertas: um ensaio clínico randomizado

Abstract Introduction and objectives: Blockade of the Erector Spinal Muscle (ESP Block) is a relatively new block, initially described for chronic thoracic pain analgesia, but it has already been described for anesthesia and analgesia in thoracic surgical procedures and, more recently, for high abdominal surgeries. The aim of the study was to compare two techniques, ESP Block and Epidural Block, with morphine and local anesthetic for postoperative analgesia of open cholecystectomy surgeries. Methods: Controlled single-blind randomized clinical trial with 31 patients (ESP Block, n = 15; Epidural, n = 16), of both genders, ages between 27 and 77 years. The ESP block was performed at the T8 level with injection of 20 mL of 0.5% ropivacaine bilaterally. The epidural block was performed at the T8-T9 space with 20 mL of 0.5% ropivacaine and 1 mg of morphine. Results: The ESP Block group presented higher mean ​​Numeric Pain Scale (NPS) values for pain in the up to 2 hour (p = 0.001) and in the 24 hour (p = 0.001) assessments. The ESP Block group had a three-fold increased risk (43.7% vs. 13.3%) of rescue opioid use in the 24 postoperative hours when compared to the epidural group (RR = 3.72, 95% CI: 0.91 to 15.31, p = 0.046). Conclusion: ESP Block did not prove to be an effective technique for postoperative analgesia of open cholecystectomy, at the doses performed in this study, having required more use of rescue opioid, and without differences in NPS. More comprehensive studies are required to assess the efficacy of ESP block for the visceral and abdominal somatic component, considering the specific blockade level.

Resumo Justificativa e objetivo: O Bloqueio do Plano do Músculo Eretor da Espinha (ESP block) é um bloqueio relativamente novo, inicialmente descrito para analgesia de dor torácica crônica, porém já descrito para anestesia e analgesia em procedimentos cirúrgicos torácicos e, mais recentemente, para cirurgias abdominais altas. O estudo objetivou comparar as técnicas de bloqueio ESP e bloqueio Epidural com morfina e anestésico local para analgesia pós-operatória de cirurgias de colecistectomia aberta. Método: Estudo clínico randomizado controlado, unicego com 31 pacientes (ESP block, n = 15; Epidural, n = 16), de ambos os sexos, idades entre 27 e 77 anos. O ESP block foi realizado no nível de T8 com injeção de 20 mL de ropivacaína 0,5% bilateral. O bloqueio Epidural foi realizado no espaço T8-T9 com 20 mL de ropivacaína 0,5% e 1 mg de morfina. Resultados: O grupo ESP block apresentou valores médios de dor pela Escala Visual Numérica (EVN) maiores nas avaliações até 2 horas (p= 0,001) e em 24 horas (p= 0,001). O grupo ESP block apresentou um risco três vezes maior - 43,7%vs.13,3% - de uso de opioide de resgate em 24 horas pós-operatórias do que o grupo epidural (RR = 3,72; 95% IC 0,91 a 15,31; p= 0,046). Conclusão: Nas doses realizadas nesse estudo, o ESP block não se mostrou uma técnica efetiva para analgesia pós-operatória de colecistectomia aberta, com mais uso de opioide de resgate e sem diferenças na escala visual numérica de dor. Necessita-se de estudos mais abrangentes avaliando a eficácia do ESP block para o componente visceral e somático abdominal, considerando o nível do bloqueio específico.

Morphometric Analysis Of The Sacral Hiatus In Indians: Its Clinical Importance

Introduction: Sacral hiatus (SH) is a significant landmark during caudal epidural block (CEB) which is employedfor analgesia and anaesthesia during a wide range of clinical conditions. This requires a thorough knowledge ofmorphometric characteristics of SH and surrounding landmarks, but variability in morphometric dimensionsexists among different populations.Aim: The aim of this study was to identify different anatomical landmarks to detect the location of SH andprovide a reference database for morphometric dimensions of SH in Indian population.Materials and Methods: The study was done on 108 dry adult human sacra. Linear measurements of the sacrawere taken with the help of digital vernier caliper and angular parameters were determined with a goniometer.Results: The most common shape of the sacral hiatus was inverted ’V’ shaped (59.3%) with the level of the apexat S4 in 66.7% and base at S5 in 86.1% cases. Morphometric dimensions of SH were found to be smaller in presentstudy as compared to reports by other researchers. Left crest-apex angle was observed to be significantly greaterthan the right crest-apex angle. (p 0.001).Conclusion: Multiple bony landmarks and their morphometric dimensions should be considered to locate the SHduring CEB. Values for various morphometric parameters of SH are less in Indians in comparison to otherpopulations, which should be contemplated during caudal epidural injections and trans-sacral thecaloscopy.

Tratamiento y desenlace obstétrico de una paciente con artrogriposis múltiple congénita / Clinical treatment and outcome of a patient with arthrogryposis multiplex congenita

Resumen ANTECEDENTES: La artrogriposis múltiple congénita es una alteración excepcional, caracterizada por contracturas musculares en diversas partes del cuerpo. Las pacientes embarazadas con esta enfermedad tienen mayor riesgo de complicaciones obstétricas. CASO CLÍNICO: Paciente de 19 años, con artrogriposis múltiple congénita, de ocho semanas de embarazo, quien acudió al servició médico para iniciar el control prenatal. Recibió asesoría de los riesgos cardiovasculares y del sistema respiratorio, secundarios a la enfermedad de base, que pudieran exacerbarse por el embarazo. El ultrasonido efectuado en la semana 22 del embarazo no reportó alteraciones estructurales. La paciente continuó en control prenatal, sin dificultad respiratoria ni alteraciones cardiovasculares. No recibió anticoagulantes profilácticos, ni manifestó signos de trombosis durante el embarazo. Se decidió la interrupción del embarazo por cesárea, debido a la limitación del movimiento de la cadera. Se programó para cirugía en la semana 38.3 del embarazo, con valoración del servicio de Cardiología, quienes reportaron fracción de eyección del ventrículo izquierdo adecuada y sin evidencia de miocardiopatía. Se aplicó anestesia por vía epidural sin complicaciones. El examen físico del neonato no mostró alteraciones. Actualmente, la madre y su hijo permanecen con buen estado de salud. CONCLUSIONES: Las pacientes embarazadas con artrogriposis múltiple congénita deben recibir asesoría de los riesgos inherentes y posibles complicaciones de la enfermedad. Es importante la intervención de un equipo multidisciplinario, para evaluar la función cardiovascular y respiratoria, además de efectuar revisiones seriadas para asegurar el bienestar materno-fetal.

Abstract BACKGROUND: Arthrogryposis multiplex congenita is a rare entity characterized by the appearance of multiple muscle contractures in various parts of the body. Pregnant patients with this condition have a higher risk of complications in obstetric management. CLINICAL CASE: A 19-year-old patient, with arthrogryposis multiplex congenita, eight weeks pregnant, attended in medical service to start prenatal care. Received advice on the cardiovascular and respiratory system risks, secondary to the underlying disease, that could be exacerbated by pregnancy. The ultrasound during the 22nd week of pregnancy did not report any structural alterations. The patient continued in prenatal control, without respiratory difficulty or cardiovascular alterations. Did not receive prophylactic anticoagulants, neither showed signs of thrombosis. We decide finished the pregnancy by caesarean section, due to the limited movement of the hip. Surgery was scheduled at week 38.3 of pregnancy, with assessment by the Cardiology service, who reported adequate left ventricular ejection fraction and no evidence of cardiomyopathy. Epidural anesthesia was applied without complications. The physical examination of the newborn showed no alterations. Currently, the mother and her son remain in good health. CONCLUSIONS: In pregnant patients with arthrogryposis multiplex congenita its important to explain the inherent risks of their condition and their possible complications. Multidisciplinary management should be performed with cardiovascular, respiratory, and serial reviews to ensure the welfare of the maternal-fetal binomial.

Videotoracoscopía con anestesia peridural en paciente despierto / Epidural anesthesia for videoassisted thoracic surgery in awake patient

Video-assisted thoracic surgery (VATS) is traditionally performed under general anesthesia and endotracheal intubation with a double lumen tube. In recent years, a growing trend towards these procedures being performed under loco regional anesthesia, particularly under epidural block with or without sedation in patients in spontaneous ventilation has appeared. It can be used to perform procedures that include pneumothorax management, wedge resection, lobectomy and surgical reduction of lung volume. The most attractive reason is to eliminate the side effects related to general anesthesia looking for a lower perioperative risks and shorter hospital stays, especially in elderly patients and those with compromised respiratory function. The thoracic epidural anesthesia has been effective allowing an adequate surgical approach, guaranteeing an idoneus level of analgesia, an optimal oxygenation, and facilitating an early postoperative recovery. We present a case of a patient undergoing to lung biopsy performed by VATS patient under epidural block and Ramsay scale sedation level III in spontaneous ventilation, who was discharged 48 hours after the surgical procedure.

La cirugía torácica asistida por vídeo se realiza tradicionalmente bajo anestesia general e intubación endotraqueal con tubo de doble luz. En los últimos años ha existido una corriente creciente hacia la realización de estos procedimientos en pacientes bajo anestesia locorregional, particularmente con bloqueo epidural con o sin sedación y en ventilación espontánea, para procedimientos que incluyen manejo de neumotórax, resección en cuña, lobectomía y cirugía de reducción de volumen pulmonar. La razón más atractiva es evitar los efectos secundarios relacionados con la anestesia general en búsqueda de menor riesgo perioperatorio y menor estancia hospitalaria, especialmente en pacientes mayores y en aquellos con función respiratoria comprometida. La anestesia epidural torácico (AET) ha sido efectiva para permitir un adecuado abordaje quirúrgico, garantizando un idóneo nivel de anestesia, una correcta oxigenación y facilitando la recuperación posoperatoria precoz]. Se presenta el caso clínico de una biopsia pulmonar realizada mediante toracoscopia en un paciente bajo AET con sedación escala Ramsay III y en ventilación espontánea, quien fue dado de alta a las 48 horas posterior a la cirugía.

Caudal Epidural Injection with a Catheter in Patients with Failure of Conventional Epidural Blocks

STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study was to analyze and report the results of caudal epidural injections using a catheter in patients in whom conventional epidural block had failed. SUMMARY OF LITERATURE REVIEW: Epidural nerve block is often used to treat chronic back pain and radicular pain in degenerative lumbar disease, and percutaneous epidural neuroplasty or surgery may be an alternative if it fails. MATERIALS AND METHODS: In total, 146 patients who were treated with caudal epidural block using a catheter were recruited for this study from January 1, 2015 to June 30, 2019. Forty-five patients who had not undergone any epidural block in the past were excluded from the study. Among patients who did not have a fracture and were followed up for at least 1 month, the medical records of 61 patients with degenerative disc herniation, spondylosis, and stenosis were reviewed retrospectively. Visual analogue scale (VAS) scores were evaluated before and after the procedure. RESULTS: Of the 61 patients who had undergone epidural block through a transforaminal caudal approach with no pain control effect, there were 18 males and 43 females. Their mean age was 66.3 years and the average follow-up period was 2.64 months. There were 46 cases of spinal stenosis, 33 cases of spondylosis, 2 cases of spondylolisthesis, 9 cases of disc herniation and 1 case of ankylosing spondylitis. The mean number of epidural blocks was 5.85 (times) before the procedure. The mean initial VAS score was 5.34 and the final follow-up VAS score was 2.70. There was a significant difference between before and after the procedure (p<0.05). The mean duration of effect after the procedure was 1.84 months and the mean number of procedures was 2.30. After the procedure, there were 4 cases of surgical treatment, 2 cases of neuroplasty, and 3 cases of epidural block using other methods over more than 1 year of follow-up. CONCLUSIONS: The result of this clinical study suggests that caudal epidural injections using a catheter may be effective for patients with low back pain who have not responded to previous epidural blocks before surgical treatment.

Effects of general anesthesia combined with epidural block or transverse abdominis plane block on intraoperative anesthetic dosages, stress response and inflammatory response in patients undergoing radical resection of colorectal cancer / 医学研究生学报

Objective The choice of perioperative analgesia regimens for radical resection of colorectal cancer is still controversial. The purpose of this study was to compare the effects of general anesthesia combined with epidural block or transverse abdominis plane block on surgical recovery of patients, and provide a basis for the choice of analgesic methods for radical resection of colorectal cancer. Methods The clinical data of 118 patients who underwent laparoscopic radical resection of colorectal cancer under general anesthesia in Affiliated Hospital of Nantong University between February 2016 and May 2018 were retrospectively analyzed, and the patients were divided into group A (epidural block, n=61) and group B (transverse abdominis plane block, n=57) according to anesthesia regimens. The two groups were given the same general anesthesia induction and maintenance medication. The dosages of general anesthetics in two groups were recorded, and the postoperative recovery situations (including first anal exhaust time, eating time, ambulation time, hospital stay and visual analogue scale score) were compared, and the stress indexes of heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO2), cortisol (Cor) and norepinephrine (NE)], immune indexes of CD4+, CD8+, CD4+/CD8+, total T lymphocyte count and natural killer cell (NK) count and inflammation indicators of human chemokine CXC ligand 8 (CXCL8), interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) were detected in two groups at different time points. Results The dosage of sufentanil in group A was lower than that in group B [(25.36±4.74) μg vs (28.43±3.69) μg] (P<0.001). The first anal exhaust time, eating time and first ambulation time in group A were shorter than those in group B (P<0.05). The VAS scores in group A were lower than those in group B at different time points (P<0.001). The levels of HR, MAP, Cor and NE in group A were lower than those in group B at T2~T3, and the SpO2 at T2 was lower than that in group B [(5.11±0.31)% vs (5.96±0.34)%] (P<0.05). At 24h after operation, the CD8+ and total T cell in group A were lower than those in group B [(20.79±13.02)% vs (26.91±10.22)%, (60.23±8.97)% vs (64.33±12.76)%] while the CD4+/CD8+ and NK cell count were higher than those in group B [(1.66±0.63) vs (1.25±0.95), (27.71±10.98)% vs (20.02±1.74) %] (P<0.05). The levels of CXCL8, IL-6 and TNF-α were lower than those in group B (P<0.05). There was no significant difference in the incidence rate of adverse reactions between group A and group B (3.28% vs 5.26%) (P>0.05). Conclusion General anesthesia combined with epidural block can reduce the dosages of anesthetic drugs in radical resection of colorectal cancer, reduce the body stress response and inflammatory response, and weaken the early immunosuppressive effects, and its overall analgesic effects are better than those of combined transverse abdominis plane block.

The relevance of regional anesthesia in orthopaedic surgery: concepts and techniques

Before the advent of anaesthesia in surgical practice, surgeons battled with patient's maximal co-operation during surgical procedures, management of pain intra-operatively and post-operatively. Anaesthesia has greatly aided in overcoming these challenges, but a sizable proportion of reduction in these challenges but approximately 30-80% of patients complain of moderate to severe pain post-operatively indicating that post-operative pain remains a problem. Controlled epidural anaesthesia and controlled peripheral nerve block which are types of regional anaesthesia provide superior pain relief during and after surgery, making regional anaesthesia of particular relevance in orthopaedic surgery. More so, general anaesthesia has some adverse effects on the outcome of operation and the patient. These adverse effects are rare but may be disastrous and life-threatening necessitating close supervision during and after general anaesthesia. Hence, the preference should be towards regional anaesthesia with regards to the choice of anaesthesia in orthopaedic surgery. This review aims to highlight some concepts and techniques on regional anaesthesia in orthopaedic surgery.

The relevance of regional anesthesia in orthopaedic surgery: advantages, disadvantages and challenges

The relevance of regional anaesthesia in orthopaedic surgery cannot be overemphasized because it has aided reduction in intra-operative and post-operative pain which has always been a challenge in surgical practice. It also reduces the risk of haemorrhage and infection. Though there are complications associated with regional anaesthesia, these complications are rare and can be anticipated; thus prompt intervention measures can be instituted. The outcome of every surgical procedure takes into consideration the risks and benefit of the method, and hence, since the benefits of regional anaesthesia in orthopaedic surgery outweighs the risks, it is highly recommended. Regional anaesthesia is of great importance in orthopaedic surgery because it offers continuous but controlled analgesia. It induces hypotension which leads to a reduction in blood loss during operation. It allows early recovery and ambulation of patients, thus reducing the risks associated with prolonged bed stay, which may, in turn, affect the overall outcome of surgery. This review aims to highlight the advantages and challenges of regional anaesthesia in orthopaedic surgery

Analysis on the Effect of General Anesthesia Combined with Epidural Block on Post-operative Cognitive Disorder for Patients with Gastric Cancer Undergoing Laparoscopic Radical Operation / 医学研究杂志

Objective To explore the effect of general anesthesia combined with epidural block for patients with gastric cancer undergoing laparoscopic radical operation.Methods Totally 62 patients with gastric cancer who received laparoscopic radical operation were randomly and equally divided into combined group(n =31) and control group (n =31).Combined group and control group was given pure general anesthesia and general anesthesia combined with epidural block,respectively.The perioperative related indicators,hemodynamics and occurrence of POCD in both groups were compared.Results The dosage of propofol in combined group was significantly lower than that in control group (P ＜ 0.05).From T2 moment,the HR was significantly increased,and MAP was reduced in control group compared with T0 moment (P ＜ 0.05).The level of MAP in combined group was significantly higher than that in control group at T2-T4 moment(P ＜ 0.05).At 1 day after operation,MMSE score in control group was significantly reduced compared with before operation,and lower than combined group (P ＜ 0.05).The incidence of POCD in combined group was significantly lower than that in control group (P ＜ 0.05).Conclusion General anesthesia combined with epidural block for patients with gastric cancer undergoing laparoscopic radical operation can reduce the dosage of anesthetic drug,maintain hemodynamic stability,and improve postoperative cognitive ability.

Effect of epidural labor analgesia on the prolactin levels of parturient / 新乡医学院学报

Objective To explore the effect of epidural labor analgesia on the prolactin (PRL) levels of parturient.Methods Sixty primipara who delivered in the First Affiliated Hospital of Xinxiang Medical University from October 2016 to May 2017 were selected as research object.The parturient were divided into observation group and control group,with 30 cases in each group.The parturient in observation group were given ropivacaine combined with sufentanil for epidural block labor analgesia;the parturient in control group took natural production method without any analgesia method.The pain score,duration of labor,milk yield,serum PRL level before analgesia and 24,48 h postpartum and the number of initial lactation at 30 rmin,24 h,48 h postpartum of maternal were compared between the two groups.Results The active period of the first stage of labor of parturient in the observation group was significantly shorter than that in the control group (P ＜ 0.05);there was no statistic difference in the latent period of the first stage of labor,the second stage of labor and the third stage of labor of parturient between the observation group and the control group(P ＜ 0.05).There was no statistic difference in the pain score of parturient between the two groups before analgesia(P ＜ 0.05);the pain score of parturient in observation group was significantly lower than that in the control group at the time point of uterine orifice open 3 cm,uterine orifice full dilatation and fetal disengagement(P＜ 0.05).There was no statistic difference in the PRL levels of parturient between the two groups before analgesia (P ＜ 0.05);the PRL level of parturient in observation group was significantly higher than that in the control group at 24,48 h postpartum(P ＜0.05).The condition of initial lactation of maternal in the observation group was significantly better than that in the control group(P ＜ 0.05).The milk yield of parturient in observation group was significantly more than that in the control group at 24,48 h postpartum (P ＜ 0.05).Conclusion Epidural analgesia can reduce the pain of parturient,shorten the active stage of the first stage of labor,increase the level of PRL and increase the milk yield of the postpartum.

Effect of lower thoracic epidural block on intestinal epithelial cell apoptosis during hemorrhagic shock and resuscitation in rats / 临床麻醉学杂志

Objective To investigate the effect of lower thoracic epidural block on intestinal epithelial cell apoptosis during hemorrhagic shock and resuscitation in rats.Methods Sixty-four male SD rats placed with lower thoracic epidural catheter were randomly divided into four groups (n=1 6 each):group Sham (sham operation),group HSR (hemorrhagic shock and resuscitation),group NS (hemorrhagic shock and resuscitation+epidural saline 100 μl/kg),and group TEA (hemorrhagic shock and resuscitation+epidural 0.075% ropivacaine 100 μl/kg).The hemorrhagic shock was made described by Chaudry.Rats were resuscitated by transfusing shed blood and normal saline 60 min after hemorrhagic shock.Malondialdehyde (MDA)content,superoxide dismutase (SOD)activity, and protein expression of Bax and Bcl-2 in intestinal epithelium were detected,and epithelial apoptosis index was calculated at 2 h after resuscitation.Results Compared with group Sham,intestinal epithe-lial MDA,Bax expression and epithelial apoptosis were significantly increased,while SOD activity were markedly decreased in groups HSR,NS and TEA (P<0.05).Compared with groups HSR and NS,intestinal epithelial MDA,Bax expression and epithelial apoptosis were significantly decreased, while SOD activity and Bcl-2 expression were markedly increased in group TEA (P <0.05 ). Conclusion Lower thoracic epidural block can enhance the antioxidant and anti-apoptotic ability,and inhibit the oxidative stress and cell apoptosis of intestinal epithelium.Therefore,it can promote the survival rate after hemorrhagic shock and resuscitation through protecting intestinal barrier.

Appropriate angle and depth in thoracic transforaminal epidural block in Koreans

BACKGROUND: Selective transforaminal epidural block has come to the for as a targetspecific modality in the treatment and diagnosis of spinal pain. Thoracic transforaminal epidural block (TTFEB) has the associated risk of pneumothorax. This article describes a retrospective study conducted using computed tomography (CT) imaging to investigate the TTFEB angle and depth appropriate to minimize the risk of pneumothorax in Koreans. METHODS: The subjects of the present study were 100 randomly selected patients between 50 and 70 years of age found be free of thoracic disease according to chest CT performed in the present hospital. On the chest CT, the superior, middle, and inferior thoracic vertebrae were observed at the T2, T7, and T11 levels, respectively. RESULTS: The average distance and the needle insertion angle from the skin point at which the needle may be inserted without piercing the lung to the intervertebral foramen were 117.8 ± 12.1 mm and 58.1 ± 6.1° at the T2 level, 85.6 ± 10.0 mm and 61.7 ± 4.3° at the T7 level, and 94.3 ± 8.7 mm and 64.4 ± 7.0° at the T11 level, respectively. CONCLUSIONS: The needle insertion at the point further than 40 mm, on the upper, middle thorax, if the needle pass from the inner vertebral body to lamina, it could be safer. However, on the lower thorax, needle could pierce the lung though the needle start from the inner vertebral body. Thus, it can be safer if the needle pass toward the exterior margin of lamina.

The comparison of intermittent epidural bolus and continuous epidural infusion mode on labor analgesia / 实用医学杂志

Objective To compare the difference between intermittent epidural bolus(IEB) combined with patient controlled epidural analgesia(PCEA)and continuous epidural infusion(CEI)combined with PCEA mode in labor analgesia. Methods It was a retrospective cohort study ,which subjects were assigned to CEI+PCEA and IEB + PCEA group. Correlated data were collected to compare the effect of the two analgesic mode on perinatal events. Results There were less consumption of ropivacaine and sufentanil per hour ,less PCEA request and actual bolus in IEB + PCEA group. There were no significant difference between the delivery mode and the percentage of low Apgar score in neonates. Conclusion IEB+PCEA mode has better analgesic effect ,meanwhile doesn't disturb the delivery mode has no effect on the neonate outcome.

Epidural ropivacaine block increasing anesthetic potency of propofol / 基础医学与临床

Objective To investigate the effects of epidural ropivacaine block combined with propofol intravenous anesthesia on CaMKⅡ and ERK1/2 total protein (T-CaMKⅡ and T-ERK1/2) and phosphorylation(p-CaMKⅡ and p-ERK1/2) levels in the hippocampus and cortex of rats.Methods Rats were randomly assigned to three groups: group P(control,propofol intravenous anesthesia),group PS(propofol and epidural normal saline) and group PR(propofol and epidural 0.5% ropivacaine).Anesthesia were performed in 72 h after epidural catheter placement.The rats in group PR received 70 μL of 0.5% ropivacaine to achieve epidural block.1% propofol was infused through rats caudal vein.Propofol dosage for anesthesia induction was 12 mg/kg,for anesthesia maintenance was 40 mg/(kg·h).Before the rats were decapitated,the depth of anaesthesia was assessed as either light anesthesia or deep anesthesia by checking of pinch withdrawalreflex,eyelid reflex and spontaneous rapid whisking of the vibrissae after propofol continuous infusion for 1 h.T-CaMKⅡ/T-ERK1/2 and p-CaMKⅡ/p-ERK1/2 in hippocampus and frontal cortex were examined by Western blot.Results 7 rats were assessed as light anesthesia and one rat as deep anesthesia in group P;6 rats were assessed as light anesthesia and 2 rats as deep anesthesia in group PS;in group PR,1 rat was assessed as light anesthesia and 7 rats as deep anesthesia.Significant differences were seen among three groups (P<0.05).In hippocampus of rats,p-CaMKⅡ(Thr286)43.7%±8.8% and p-ERK1/2 32.4%±7.9% in group PR were significantly lower than those in group P (100%,P<0.05).Conclusions Epidural ropivacaine block may strengthen the depth of anesthesia achieved with propofol intravenous anesthesia.The decrease of p-CaMKⅡ(Thr286) and p-ERK1/2 in hippocampus of rats may explain the effects of epidural block.

Effects of sufentanil-midazolam intravenous anesthesia combined with epidural block on hemodynamics and anesthesia awake / 中国生化药物杂志

Objective To investigate the effect of sufentanil midazolam intravenous anesthesia combined with epidural block on hemodynamics and postoperative consciousness after anesthesia.Methods 40 cases undergoing acute chest and abdominal surgery from January 2015 to December 2016 in Taizhou tumor hospital as the research objects, were randomly divided into the control group and the experimental group, 20 cases in each group.The control group were received sufentanil midazolam intravenous anesthesia, and the experimental group were received sufentanil midazolam intravenous anesthesia combined with epidural block.Hemodynamics and anesthesia consciousness in the two groups were compared.Results Compared with pre-induction, the diastolic and systolic blood pressure and the heart rate were significantly decreased at pre-intubation (P<0.05).There were no significant differences between the two groups at other observation time points.The intravenous anesthesia medication in the experimental group was significantly less than that in the control group, the difference was statistically significant (P<0.05).The recovery time in the experimental group was (31.5±4.2) min, the extubation time was (4.8±1.5) min, and the basic awake time was (8.2±2.4) min.The above data were significantly better than those in the control group (P<0.05).No complications such as postoperative agitation and respiratory depression occurred in the experimental group and the control group.Conclusion Sufentanil midazolam intravenous anesthesia combined with epidural block, hemodynamic stability, it can reduce the amount of anesthesia drugs and shorten the recovery time to some extent, and is worthy of clinical application.

Effects of Small Dose of Bupivacaine Lumbar-Epidural Block on Related Indexes in Women Underwent Ce-sarean Section / 中国药房

OBJECTIVE:To investigate the effects of small dose of bupivacaine lumbar-epidural block on related indexes inwomen underwent cesarean section. METHODS:124 singleton term primipara underwent elective cesarean section were randomly divided into observation group(62 cases)and control group(62 cases). Observation group received 0.5% bupivacaine 7.5 mg lum-bar anesthesia+1.6% lidocaine epidural block. Control group received 0.5% bupivacaine 10 mg lumbar anesthesia+1.6% lidocaine epidural block. HR,SBP,DBP,onset time of sensory block,fixation time of block level,operation start time,the occurrence of traction reaction and supine hypotensive syndrome,the application of ephedrine,Apgar score the occurrence of ADR were ob-served in 2 groups before anesthesia(T0),1(T1),3(T2),5 min(T3)after anesthesia,at skin incision(T4),after fetal disengage-ment(T5). RESULTS:There was no statistical significance in HR,SBP and DBP between 2 groups at T0(P>0.05). There was no statistical significance in HR,SBP and DBP of observation group at different time points(P>0.05). At T1-3,SBP and DBP of con-trol group were significantly lower than at T0 and observation group;HR was significantly higher than at T0 and observation group, with statistical significance(P0.05);there was no statistical significance in above 3 indexes of control group at T4-5,compared to at To and observation group(P>0.05). The onset time of sensory block,fixation time of block level and operation start time in observation group were all longer than control group;the incidence of supine hypotensive syndrome,the number of ephedrine cases,the amount of ephed-rine,the incidence of nausea and vomiting,the incidence of postoperative urinary retention were significantly lower than control group;the incidence of traction reaction was significantly higher than control group,with statistical significance(P0.05). CONCLUSIONS:The small dose of bupivacaine lumbar-epidural block for women underwent cesarean section keep he-modynamics stable and reduce the incidence of supine hypotensive syndrome without increasing the incidence of ADR.