Continuous Cervical Epidual Anesthesia in a Patient Suffering from a Severe Pain Caused by Pancoast Tumor: Case Report

Pancoast tumor is a relatively rare form of non-small cell lung cancer. Due to its invasion of the brachial plexus, it often causes severe pain and sometimes it is difficult to control the pain. Radiotherapy is often chosen not only for the treatment of the cancer but also for pain relief in Pancoast tumors. However, radiotherapy requires the patient to be kept in a resting supine position, which can cause severe pain during treatment or make it impossible to continue treatment due to pain. In this article, we report our experience with a patient who presented with severe pain in the shoulder and upper extremities due to a Pancoast tumor. Although patient had difficulty in maintaining a resting supine position, continuous cervical epidural anesthesia enabled him to complete radiotherapy under pain control. Despite the risk of infection and bleeding from catheterization, it is important to consider the indication of continuous epidural anesthesia when pain control is poor.

Investigation and analysis about parturition related knowledge of patient-controlled epidural analgesia among pregnant women / 中国实用护理杂志

Objective To know the awareness level of patient-controlled epidual analgesia in labor related knowledge,and to provide evidence for health education,develop a comprehensive intervention program to reduce the rate of cesarean section.Methods Investigation on knowledge of patient controlled epidural analgesia during labor for a total of 400 pregnant women on Maternal and Child Health Hospital of Taiyuan City,MCH Hospital of Shanxi Province by questionnaire.Compared different characteristics of the pregnant women's scores about control epidural analgesia childbirth knowledge by nonparametric test,knowledge score of multi-factor analysis by multiple linear regression analysis.Results The maximum score of pregnant women-controlled epidural analgesia delivery knowledge was 13,the minimum score was 0,the median score was 4,range interquartile was 5.Different pregnant women with different age,education level,number of weeks of gestation,pregnancy,family income,and condition of parnatal care had different scores of knowledge of patient-controlled epidural analgesia,the difference was significant,P＜0.05.Multiple linear regression analysis showed that:pregnant women's education,gestational age,the average monthly household income can be explained by maternal knowledge score of 61.4％ of the variation.Conclusions The level of pregnant women-controlled epidural analgesia childbirth knowledge is low,we need to strengthen the natural childbirth education,and take a variety of modes of propaganda and increase their level of knowledge,enhance confidence of natural childbirth in pregnant women,so as to achieve the purpose of reducing cesarean section rate.

A retrospective analysis of removal of 18 cases of chordoma in skull base via the extended subfrontal epidual approach / 中国基层医药

Objective To study the surgical techniques of the extended subfrontal epidual approach to resect chordoma in skull base.Methods 18 cases of chordoma in skull base treated mierosurgically were analyzed retrospectively.Results Total resection were achieved in 15 patients(83%),gross resection in 3 patients(17%).There was no complication in all cases.Conclusion The microsurgery for chordoma in skull base via the extended subfrontal epidual approach is of the benefits such as clear and wide fields of vision,and minimize brain trauma.Lumber drain placement and the skull base reconstruction could improve the rate of total tumor removal and reduce complications.

Pharmacokinetics of Lidocaine and Bupivacaine that Injected into the Epidural Cavity of Children During Epidural Anesthesia / 中国药房

OBJECTIVE:To study the pharmacokinetics of lidocaine and bupivacaine in children undergoing epidural anesthesia so as to evaluate the safety and efficacy of this anesthetic method.METHODS:A total of 30 children who were expected to undergo surgery for undescended testis,hernia or high ligature for hydrocele were assigned to receive 2% lidocaine(5 mg?kg-1) plus 0.75% bupivacaine(1.875 mg?kg-1)(single epidural dose) by epidural anesthesia.Plasma concentrations of lidocaine and bupivacaine were determined by HPLC.Pharmacokinetics parameters were calculated and fitted by using DAS ver 2.0 pharmacokinetic program.RESULTS:The plasma concentration-time curves of lidocaine and bupivacaine were in line with a two-compartment model.The main pharmacokinetic parameters of lidocaine vs.bupivacaine were as follows:tmax 27.0 vs.33.0 min;t1/2? 43.97 min vs.73.52 min;Cmax 2.411 mg?L-1 vs.1.475 mg?L-1;AUC0～∞ 144.714 mg?min?L-1 vs.168.541 mg?min?L-1.CONCLUSION:The dosages of the local anesthetics injected into the epidural cavity of children are proven to be safe and effective.

The Analgesic Effect of Postoperative Combined Epidural, Soft Tissue, and Intra-articular Injection of Morphine and Bupivacaine in Patients undergoing Total Knee Arthroplasty / 대한마취과학회지

BACKGROUND: Epidural opioids and local anesthetics provide excellent postoperative analgesia. In addition, soft tissue and intra-articular injection of bupivacaine and morphine may have a beneficial analgesic effects after total knee arthroplasty (TKA). This study was designed to assess the additional analgesic effect of combined soft tissue, and intra-articular injection of morphine and bupivacaine in patients undergoing TKA under spinal anesthesia with continuous epidural morphine and bupivacaine injection. METHODS: Forty patients aged 55 to 75 years for a TKA under spinal anesthesia were randomly divided into 2 groups. The both group of patients received a continuous epidural infusion using a two-day infusor containing morphine 5 mg in 100 ml of 0.125% bupivacaine. The experimental group of patients (n = 20) received soft tissue, and intra-articular injection containing 10 mg morphine in 100 ml bupivacaine 0.125%. The control group of patients (n = 20) received soft tissue, and intra-articular injection of 100 ml normal saline. Postoperative pain was assessed using the visual analog scale (VAS) at 1, 2, 4, 8, 12, 24, and 48 h postoperatively and side effects, such as hypotension, nausea, vomiting, pruritus, and respiratory distress were recorded. Whenever patients demanded supplemental analgesia, diclofenac sodium 75 mg was injected intramuscularly and the need for additional analgesic requirement was recorded. RESULTS: The experimental group of patients had significantly lower pain score and analgesic requirements than the control group for 2 days. There was no difference in the incidence of side effects between groups. CONCLUSIONS: Combined soft tissue, and intra-articular injection of morphine and bupivacaine with continuous epidural morphine and bupivacaine infusion reduces postoperative pain and supplementary analgesic requirements than continuous epidural morphine and bupivacaine infusion only in patients undergoing TKA.

A Comparison of Epidural 0.2% Ropivacaine Alone and 0.15% Ropivacaine with 150 microgram/ml Alfentanil for Postoperative Patient-Controlled Epidual Analgesia after Major Abdominal Surgery / 대한마취과학회지

BACKGROUND: The lower levels of cardiotoxicity and motor block make ropivacaine well suited as an epidural infusion for postoperative analgesia. This study examined the analgesic efficacy of an epidural infusion of ropivacaine alone and in combination with alfentanil after major abdominal surgery. METHODS: Thirty patients undergoing major abdominal surgery under general anesthesia were divided into two groups receiving patient-controlled thoracic epidural analgesia with 0.2% ropivacaine (Group I) and 0.15% ropivacaine +150 microgram/ml alfentanil (Group II). The motor block, side effects, VAS (visual analog pain scale) score on coughing and resting, additional analgesics use, and patient's satisfaction were checked for 24 hours after a loading dose injection. RESULTS: The VAS score in group II was significantly lower than in group I, and the patients in group II were more satisfied than those in group I (P < 0.05). However, there were more side effects in group II. CONCLUSIONS: Postoperative epidural infusion of 0.15% ropivacaine with 150 microgram/ml alfentanil is more effective than 0.2% ropivacaine only.

Evaluation of the effect of preemptive analgesia with continuous epidual anesthesia in total knee arthroplasty / 中国矫形外科杂志

[Objective]To observe the effect of preemptive analgesia with continuous epidual anesthesia in total knee arthroplasty.[Methods]Fifty-four patients who were treated in author's hospital were randomly assigned into two groups with 27 patients in each.One group was treated with 0.125% ropivacaine 2 ml/h through epidual catheter since 12 hours before the operation.The other group was given saline at the same rate.All the patients received general anaesthesia in the operation.The use of patient controlled analgesia(PCA) with epidual anesthesia was initiated 48 hours after operation.PCA was used as a supplement when the patients comldn't bear the pain.The following variations were compared between these two groups:visual analog score(VAS),the incidences of complication,deep vein thrombosis(DVT),the time of the ability to actively reach 90 degree knee flexion,the range of motion(ROM) and the chronic pain after operation.[Results]The following variations were statistically significantly lower in ropivacaine group than that in the saline group:VAS,DVT,the time to reach 90 degree knee flextion,while ROM 6 months and 1 year after operation were significant higher.There were no statistically significant differences between groups in the incidence of the side effects during the two days after the operation and the chronic pain for a longer time.[Conclusion]Preemptive analgesia with continuous epidual anesthesia can alleviate the early stage of the pain after total knee arthroplasty,decrease the incidence of the complication and increase the rang of motion without obvious side effects.