ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
[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.