Neumoencéfalo como complicación de bloqueo regional epidural por radiculopatía lumbosacra

Introducción: El neumoencéfalo (sinonimia: aerocele o neumatocele intracerebral), se define como la presencia de gas dentro de cualquiera de los compartimentos intracraneales (intraventricular, intraparenquimatosa, subaracnoidea, subdural y epidural). Objetivo: Describir los hallazgos clínicos, estudios complementarios, conducta terapéutica y evolución de un caso con neumoencéfalo como complicación de bloqueo regional epidural por radiculopatía lumbosacra. Presentación de caso: Se presentó un paciente masculino de 57 años de edad que comenzó con un cuadro súbito de desorientación, excitabilidad psicomotriz y convulsiones tónico-clónicas, a partir de una inyección epidural de metilprednisolona como método analgésico. Conclusiones: El caso presentado exhibió manifestaciones neurológicas inespecíficas, la aparición súbita posterior al proceder invasivo hizo sospechar en un evento neurológico agudo o fenómeno tromboembólico. Los estudios complementarios como la tomografía axial computarizada craneal simple, permitió su diagnóstico para tener una conducta consecuente. El manejo conservador del neumoencéfalo como complicación del uso de anestesia epidural, constituyó una conducta terapéutica eficaz y repercutió en la satisfactoria evolución del paciente.

Introduction: Pneumocephalus (synonym: aerocele or intracerebral pneumatocele), is defined as the presence of gas within any of the intracranial compartments (intraventricular, intraparenchymal, subarachnoid, subdural and epidural). Objective: To describe the clinical findings, complementary studies, therapeutic conduct and evolution of a case with pneumocephalus as a complication of regional epidural block due to lumbosacral radiculopathy Case presentation: A 57-year-old male patient was presented who began with a sudden episode of disorientation, psychomotor excitability and tonic-clonic seizures, following an epidural injection of methylprednisolone as an analgesic method. Conclusions: The case presented exhibited non-specific neurological manifestations, the sudden appearance after the invasive procedure raised suspicion of an acute neurological event or thromboembolic phenomenon. Complementary studies such as simple cranial computed axial tomography, allowed its diagnosis to have a consistent conduct. The conservative management of pneumocephalus as a complication of the use of epidural anesthesia constituted an effective therapeutic approach and had an impact on the patient's satisfactory evolution.

Estado actual de la cefalea postpunción meníngea en un hospital colombiano / Status of post-dural puncture headache in a Colombian hospital

Introducción: La cefalea postpunción meníngea (CPPM) posterior a la anestesia raquídea es una de las complicaciones más frecuentes asociadas a factores intrínsecos del paciente y de la técnica anestésica. Objetivo: Describir la frecuencia y los factores asociados con el desarrollo de la cefalea postpunción meníngea. Materiales y métodos: Serie retrospectiva de pacientes que ingresaron a un hospital de segundo nivel y se les confirmó el diagnóstico de cefalea secundaria a la anestesia raquídea. Resultados: Serie de 49 casos, 88 % de sexo femenino y 12 % de sexo masculino, con una edad media de 27,7 años. Los procedimientos quirúrgicos con desenlace de CPPM fueron: cirugías de ginecología y obstetricia (63 %), cirugías de urgencias de otras especialidades (28 %) y cirugías electivas (8 %). La técnica anestésica se realizó con agujas biseladas tipo Quincke calibre 25 gauge (G) en 14%, calibre 26 G 33 % y 27 G 53 %. El 51 % se realizó en posición de sedestación y el 49 % en decúbito lateral izquierdo. El 10% de los casos se manejó con parche hemático, en tanto que el antecedente de migraña se presentó en el 8 %. Discusión: En la actualidad, el uso de agujas con diseño de punta cónica es el estándar de oro, ya que permite obtener resultados confiables y disminuye complicaciones como la CPPM. Conclusión: La CPPM luego de una anestesia espinal se relacionó con factores como la edad (joven), el sexo (femenino) y el uso de agujas biseladas. Los otros factores de riesgo identificados fueron poco concluyentes, aunque no se pueden descartar, debido a la naturaleza de este estudio.

Introduction: Post dural puncture headache (PDPH) following spinal anesthesia is one of the most frequent complications associated with intrinsic patient and anesthetic technique factors. Objective: To describe the frequency and associated factors related to the development of PDPH. Materials and methods: Retrospective series of patients admitted to a second level hospital with a confirmed diagnosis of headache secondary to spinal anesthesia. Results: Series of 49 cases, 88 % female and 12 % male, mean age 27.7 years. The surgical procedures resulting in CPPM were gynecology and obstetrics surgeries 63 %, emergency surgeries of other specialties 28 % and elective surgeries 8 %. The anesthetic technique was performed with beveled needles Quincke type 25 gauge (G) in 14 %, 26 G gauge 33% and 27 G 53 %. In the seated position 51 % and in the left lateral decubitus position 49% were performed. A blood patch was used in 10 % of the cases and a history of migraine was present in 8 %. Discussion: The use of needles with conical tip design is currently the gold standard, they give reliable results and reduce complications such as PDPH. Conclusion: PDPH after spinal anesthesia was related to factors such as age (young), sex (female) and the use of traumatic needles. The other risk factors identified were inconclusive, although they cannot be ruled out due to the nature of this study.

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.

Descripción de analgesia de parto con lidocaína o bupivacaina y Apgar al nacer. Estudio observacional descriptivo retrospectivo

El trabajo de parto lleva con este la experiencia que causa uno de los dolores más intensos que se han descrito. En el Instituto de Seguridad Social de El Salvador (ISSS) se registran aproximadamente 600 a 700 partos vaginales por mes y de estos aproximadamente 10-20% solicitan analgesia para trabajo de parto, la cual el servicio de anestesia provee a través del abordaje epidural. Es conocido que se considera que el medicamento ideal para la analgesia de trabajo de parto es la bupivacaína o lidocaína 3, sin embargo, es de especial importancia describir el puntaje de APGAR de los recién nacidos de madres que recibieron cualquiera de estos dos fármacos por la vía ya mencionada. Objetivo: Determinar cómo influye el uso de lidocaína y bupivacaína como anestésico epidural sobre el puntaje APGAR posterior al nacimiento en mujeres embarazadas en fase activa del trabajo de parto con necesidad de analgesia epidural. Métodos: El presente es un estudio observacional descriptivo retrospectivo de fuentes primarias. El servicio de anestesiología del Hospital Materno Infantil Primero de Mayo cuenta con un registro sobre cuántos y a cuáles pacientes se les administra analgesia epidural por lo que el equipo investigador realizó una revisión de la técnica anestésica y se describe el Apgar al final del parto por vía vaginal en aquellas pacientes que recibieron analgesia epidural con lidocaína o bupivacaína. Se realizó el filtrado con la base de datos de Excel utilizando criterios de inclusión y exclusión, logrando incluir finalmente 81 pacientes en el análisis de los datos. Se encontró durante el escrutinio de estos que a 25 de estas se les realizó cesárea de emergencia y en 6 de estos mismos expedientes no se consignó de manera completa todos los datos necesarios para el análisis de ello, por lo que se utilizaron finalmente 51 expedientes clínicos para la realización de la presente investigación. Resultados: El APGAR promedio de los pacientes que recibieron analgesia de trabajo de parto con bupivacaína es de 8.75 y 8.9 al minuto y cinco minutos respectivamente y el promedio de APGAR alcanzado por los recién nacidos de pacientes que recibieron analgesia de trabajo de parto con lidocaína es de 9 puntos al minuto y cinco minutos. Conclusión: El promedio de APGAR en pacientes que recibieron bupivacaína es de 8.75 y el de lidocaína es de 9. (provisto por Infomedic International)

Labor brings with it the experience that causes one of the most intense pains ever described. At the Social Security Institute of El Salvador (ISSS) approximately 600 to 700 vaginal deliveries are registered per month and of these approximately 10-20% request labor analgesia, which the anesthesia service provides through the epidural approach. It is known that the ideal drug for labor analgesia is considered to be bupivacaine or lidocaine 3, however, it is of special importance to describe the APGAR score of newborns born to mothers who received either of these two drugs by the aforementioned route. Objective: To determine how the use of lidocaine and bupivacaine as epidural anesthetic influences the post-birth APGAR score in pregnant women in the active phase of labor requiring epidural analgesia. Methods: The present is a retrospective descriptive observational observational study from primary sources. The anesthesiology service of the Hospital Materno Infantil Primero de Mayo has a record of how many and to which patients epidural analgesia is administered, so the research team conducted a review of the anesthetic technique and described the Apgar at the end of vaginal delivery in those patients who received epidural analgesia with lidocaine or bupivacaine. Filtering was performed with the Excel database using inclusion and exclusion criteria, finally including 81 patients in the data analysis. It was found during the scrutiny of these that 25 of them had undergone emergency cesarean section and in 6 of these same records not all the data necessary for the analysis were completely recorded, so that 51 clinical records were finally used for the present investigation. Results: The average APGAR of the patients who received labor analgesia with bupivacaine was 8.75 and 8.9 at one minute and five minutes respectively, and the average APGAR achieved by the newborns of patients who received labor analgesia with lidocaine was 9 points at one minute and five minutes. Conclusion: The average APGAR in patients who received bupivacaine is 8.75 and that of lidocaine is 9. (provided by Infomedic International)

Several challenges associated with the anesthetic management of Emery-Dreifuss muscular dystrophy patients: case report

Abstract Emery-Dreifuss Muscular Dystrophy is a very rare type of muscular dystrophy, associated with contractures, atrophy, and muscle weakness, besides cardiomyopathy with severe arrhythmias. Published studies focusing on this disorder are scarce. We describe the anesthetic management of a male patient with Emery-Dreifuss Muscular Dystrophy, to be submitted to umbilical and inguinal hernioplasty and hydrocele repair under epidural anesthesia. The anesthesia approach enabled us to circumvent the patient's susceptibility to malignant hyperthermia and his potentially difficult airway, in addition to maintaining hemodynamic stability. The day after surgery the patient resumed walking, and two days later he was discharged from the hospital.

Fidel Pagés, el auténtico descubridor de la anestesia epidural, en el centenario de su publicación Anestesia metamérica (1921-2021) / Fidel Pagés, the true discoverer of epidural anesthesia, on the centenary of his publication Anestesia metamérica (1921-2021)

Resumen: Pocas han sido las Figuras españolas que han aportado alguna interesante novedad al mundo de la anestesia, pero ninguna tan injustamente tratada y olvidada como la de Pagés, verdadero pionero de la anestesia epidural, que él denominaría «anestesia metamérica¼ en su artículo publicado en el mes de marzo de 1921 en la Revista Española de Cirugía, fundada por él mismo. Años después, en 1931, Dogliotti, profesor de Cirugía de Módena publicó sus experiencias sobre la anestesia epidural, a la que llamó «anestesia peridural segmentaria¼, ignorando el trabajo de Pagés publicado 10 años antes. El trabajo de Dogliotti fue rápidamente reconocido, asumiendo todos los méritos de la paternidad de la técnica epidural, quedando Pagés relegado a un olvido injusto que con este trabajo tratamos de reparar. La idea central de este texto versará sobre el reconocimiento de Pagés como verdadero promotor del abordaje epidural con fines quirúrgicos. Destacar sus ideas innovadoras sobre el bienestar del paciente y la minimización de los efectos adversos de las técnicas anestésicas y quirúrgicas, así como valorar una obra que, aunque corta, bien podría incluirse entre los mejores cirujanos españoles de principio del siglo XX, un cirujano con alma de anestesiólogo.

Abstract: Few Spanish Figures have contributed any interesting novelty to the world of anesthesia. But none so unjustly treated and forgotten such as Pagés, a true pioneer of epidural anesthesia, which he would call «metameric anesthesia¼ in his article published in March 1921 in the Spanish Journal of Surgery, founded by himself. Later, in 1931, Dogliotti, Modena Professor of Surgery published his experiences on epidural anesthesia, which he called «segmental peridural anesthesia¼, ignoring Pagés work published 10 years earlier. Dogliotti's work was quickly recognized, assuming all the merits of the paternity of the epidural technique, leaving Pagés relegated to an unjust oblivion that with this work we try to repair. The central idea of this text will focus on the recognition of Pagés as a true promoter of the epidural approach for surgical purposes. Highlight his innovative ideas about patient well-being and minimizing the adverse effects of anesthetic and surgical techniques. As well as assessing a work that, although short, could well be included among the best Spanish surgeons of the early twentieth century, a surgeon with the soul of an anesthesiologist.

It's not always postdural puncture headache: a case report and note to the astute anesthesiologist

Abstract Dural puncture is either diagnosed by unexpectedly profound response to medication test dose or development of a postpartum postural headache. Epidural blood patch is the gold standard for treatment of PDPH when conservative management fails. However, postpartum headaches can be resistant to multiple epidural blood patches. In such cases, preexisting intracranial processes should be considered and ruled out. We report here the unique case of a pregnant patient who developed a resistant headache in the postpartum period related to an incidental intracranial aneurysm. Subsequent treatment with endovascular embolization adequately relieved her symptoms. Early surgical consultation and a multidisciplinary team approach involving neurology and neuroimaging is required for successful management of patients such as the one described here.

Effects of dezocine combined with sufentanil on continuous epidural analgesia after cesarean section / 中国基层医药

Objective:To investigate the effects of dezocine combined with sufentanil on continuous epidural analgesia after cesarean section.Methods:Eighty-six pregnant women who were scheduled for cesarean section in Guoyang Hospital of Traditional Chinese Medicine from February to December 2021 were included in this randomized controlled study. These women were divided into an observation group and a control group ( n = 43/group). The women in the observation group underwent epidural analgesia with dizocine, sufentanil, and ropivacaine, while those in the control group underwent epidural analgesia with dizocine and ropivacaine. The visual analogue score, Ramsay sedation score, Bruggrmann comfort scale score, and the incidence of adverse reactions were compared between the two groups. Results:At 4, 8, 12, 24 hours after surgery, the visual analogue score (VAS) in the observation group was significantly lower than that in the control group ( t = 2.34, 5.89, 15.36, 16.23, all P < 0.05). At 4, 8, 12, and 24 hours after surgery, Ramsay sedation score in the observation group was significantly higher than that in the control group ( t = -6.31, -7.64, -7.49, -7.41, all P < 0.001). At 4, 8, 12, and 24 hours after surgery, Bruggrmann comfort scale score in the observation group was significantly higher than that in the control group ( t = -7.60, -10.40, -14.53, -13.80, all P < 0.001). There was a significant difference in the number of effective analgesic pump compressions between the observation and control groups [(3.00 ± 1.41) times vs. (7.23 ± 1.31) times, t = 14.42, P < 0.001]. No adverse reactions were observed in the observation group within 24 hours after surgery. Conclusion:Dezocine combined with sufentanil for epidural analgesia can effectively improve the analgesic effects after cesarean section and is highly safe.

Effects of thoracic segment epidural anesthesia on inflammatory factors in patients undergoing lung cancer surgery / 中国基层医药

Objective:To investigate the effects of thoracic segment epidural anesthesia on inflammatory factors in patients undergoing lung cancer surgery.Methods:The clinical data of 136 patients who underwent lung cancer surgery in the Second People's Hospital of Liaocheng from June 2020 to May 2022 were retrospectively analyzed. According to anesthesia methods, these patients were divided into an observation group ( n = 89) and a control group ( n = 47). The observation group was given thoracic segment epidural anesthesia, while the control group was given remifentanil infusion anesthesia. The tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels in the epithelial lining fluid collected from the non-dependent lung, the plasma levels of TNF-α, IL-6, and malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, the incidence of complications, the incidence of re-operations, numeric rating scale score, and the length of hospital stay were compared between the two groups. The effects of different anesthesia methods on lung cancer surgery were evaluated. Results:In each group, TNF-α, IL-6, and IL-10 levels in the epithelial lining fluid were significantly increased 30 minutes after termination of one-lung ventilation (T2) compared with those measured before one-lung ventilation (T1) ( t = 7.71, 77.10, 7.59, 3.41, 57.51, 5.74, all P < 0.05). In the observation group, TNF- α [(1.59 ± 0.53) ng/L, (1.89 ± 0.64) ng/L] measured at T1 and T2, IL-6 [(2.96 ± 0.82) ng/L] and IL-10 [(1.99 ± 0.53) ng/L] measured at T1 were significantly higher compared with those measured at the corresponding time points in the control group ( t = 10.45, 2.59, 2.00, 7.19, all P < 0.05). In the observation group, IL-6 measured at T2 [(38.91 ± 5.84) ng/L] was significantly lower than that in the control group ( t = 33.25, P < 0.001), and IL-10 measured at T2 [(2.51 ± 0.67) ng/L] was slightly, but not significantly higher than that in the control group ( P > 0.05). There was no significant difference in the plasma level of TNF- α measured at T1 and T2 between the two groups (both P > 0.05). Plasma levels of IL-6 in the two groups [(42.98 ± 5.29) ng/L, (27.93 ± 4.17) ng/L] measured at T2 were significantly increased compared with those measured at T1 ( t = 54.14, 61.06, both P < 0.001). In the observation group, TNF-α measured at T2 [(1.60 ± 0.56) ng/L] and IL-6 measured at T1 and T2 [(0.92 ± 0.16) ng/L, (27.93 ± 4.17) ng/L] were significantly lower compared with the control group ( t = 3.39, 6.96, 18.20, all P < 0.05). There were no significant differences in plasma level of malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, numeric rating scale score, the incidence of complications, the incidence of re-operation, and the length of hospital stay between the two groups (all P > 0.05). Conclusion:Thoracic segment epidural anesthesia can reduce the local inflammatory response of the lung during lung cancer surgery.

Analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids / 中国基层医药

Objective:To investigate the analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids. Methods:Fifty patients with uterine fibroids undergoing uterine artery embolization admitted to The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2019 to December 2021 were included in this study. They were divided into an observation group and a control group ( n = 25/group). Patients in the observation group used an epidural analgesia pump for pain relief, while patients in the control group used an intravenous analgesia pump for pain relief. At 1, 6, 12, and 24 hours after surgery, pain severity was compared between the two groups using the Visual Analogue Scale. Comfort level was compared between the two groups using the Bruggemann Comfort scale. Before and after surgery, respiratory rate, heart rate, blood pressure, and adverse reactions were compared between the two groups. Results:At 1 hour after surgery, the Visual Analogue Scale score in the observation group was significantly lower than that in the control group [3.00 (2.00, 5.50) vs. 7.00 (6.00, 8.00), Z = -3.84, P < 0.05]. At 6, 12, and 24 hours after surgery, there was a significant difference in the Visual Analogue Scale score between the two groups (all P > 0.05). Within 24 hours after surgery, the use of opioid analgesics in the observation group was less than that in the control group [16.00% (4/25) vs. 88.00% (22/25), χ2 = 25.96, P < 0.001]. At 1 hour after surgery, the Bruggemann Comfort Scale score in the observation group was significantly higher than that in the control group [0.00 (0.00, 0.50) vs. 0.00 (0.00, 0.00), Z = 2.08, P < 0.05]. At 6, 12, and 24 hours after surgery, there was no significant difference in the Bruggemann Comfort Scale score between the two groups (all P > 0.05). After surgery, heart rate was significantly decreased in each group compared with before surgery (both P < 0.05). There were no significant differences in respiratory rate and mean arterial pressure between the two groups before and after surgery (both P > 0.05). There were no significant differences in the incidences of postoperative nausea, vomiting, and fever between the two groups (all P > 0.05). Conclusion:The epidural analgesia pump used for uterine artery embolization in the treatment of uterine fibroids has a better analgesic effect and provides more comfort and is safer than the intravenous analgesia pump. The former is worthy of clinical promotion.

Clinical efficacy of combined spinal and epidural anesthesia with isobaric bupivacaine in older adult patients undergoing artificial femoral head replacement / 中国基层医药

Objective:To investigate the clinical efficacy of combined spinal and epidural anesthesia with isobaric bupivacaine in older adult patients undergoing artificial femoral head replacement.Methods:The clinical data of 50 older adult patients who underwent artificial femoral head replacement in Zhuji Third People's Hospital between January 2016 and January 2020 were retrospectively analyzed. The patients were divided into a control group ( n = 22) and a combined anesthesia group ( n = 28) according to different anesthesia methods. The control group was subjected to epidural anesthesia with bupivacaine. The combined anesthesia group underwent combined spinal and epidural anesthesia with isobaric bupivacaine. The excellent and good rate of anesthesia as well as heart rate and mean arterial pressure measured before and 10 minutes after anesthesia, at 1 hour of surgery and at the end of surgery were compared between the two groups. Time to anesthesia onset and time to block completion were recorded in each group. Results:The excellent and good rate of clinical efficacy in the combined anesthesia group was significantly higher than that in the control group [85.71% (24/28) vs. 59.09% (13/22), χ2 = 4.54, P < 0.05]. There were no significant differences in heart rate and mean arterial pressure between the two groups before and 10 minutes after anesthesia, at 1 hour of surgery and at the end of surgery ( t = 0.83, 0.60, 1.13, 1.21; 0.98, 0.60, 0.85, 0.88, P > 0.05). The time to anesthesia onset and the time to block completion in the combined anesthesia group were shorter than those in the control group ( t = 4.99, 2.29, both P < 0.05). Conclusion:Combined spinal and epidural anesthesia with isobaric bupivacaine can increase the excellent and good rate of anesthesia effects and has no obvious effect on hemodynamics in patients undergoing artificial femoral head replacement. Combined spinal and epidural anesthesia takes a shorter time to anesthesia onset and a shorter time to block completion than spinal or epidural anesthesia.

Parotid duct anastomosis with an epidural catheter as a stent and evaluation of postoperative gland function / 口腔疾病防治

Objective @#To investigate the feasibility of epidural catheters in parotid gland duct anastomosis and the function of the affected side gland after parotid gland duct anastomosis. @* Methods@# Thirteen patients who were treated in the Department of Oral and Maxillofacial Surgery of Xuzhou Central Hospital using an epidural catheter as the scaffold for parotid gland catheter anastomosis were enrolled from Jan. 2019 to June 2021. The swelling, salivary fistula and catheter patency in the parotid gland area were evaluated two weeks after the operation. 99mTcO4- single photon emission computed tomography (SPECT) was used for quantitative detection of salivary gland secretion function@*Results@# Thirteen patients had no swelling or salivary fistula in the parotid gland area of the affected side two weeks after the operation, and the catheter secretion was unobstructed. There was no significant difference in the uptake rate between the parotid gland on the affected side and the parotid gland on the healthy side (t = -0.859, P = 0.399), and there was no significant difference in the excretion rate between the parotid gland on the affected side and the parotid gland on the healthy side (t = 0.693, P = 0.495). The parotid gland excretion function of the affected side was excellent three months after the operation.@*Conclusion @#Parotid duct anastomosis with an epidural catheter as the stent has good feasibility, and parotid gland secretion function recovers well after the operation, which is worthy of clinical application.

Determination of 50% effective concentration of ropivacaine plus sufentanil in dural puncture epidural analgesia for labor / 中国医师进修杂志

Objective:To determine the 50% effective concentration (EC 50) of ropivacaine plus sufentanil for labor analgesia using the dural puncture epidural technique. Methods:Using the method of prospective study, sixty parturients requiring labor analgesia in Dalian Women and Children′s Medical Group from May 2021 to May 2022 were divided into six groups using a random number table and administered 0.3 mg/L sufentanil and ropivacaine at different concentrations: 0.05% (group D1), 0.06% (group D2), 0.07% (group D3), 0.08% (group D4), 0.09% (group D5), and 0.1% (group D6). A probit model was constructed to compute the EC 50 values and 95% confidence intervals (95% CI) of ropivacaine plus sufentanil in dural puncture epidural analgesia (DPEA) for labor. The pain intensity of uterine contractions before labor analgesia and 30 min after administration was recorded and assessed on a numeric rating scale (NRS), and decreases in blood pressures and heart rates, vomiting and nausea, postpartum headaches, and fetal bradycardia were documented. Results:When using ropivacaine plus sufentanil for labor analgesia via DPE, the EC 50 was 0.061%, and the 95% CI ranged from 0.051 to 0.067; the 90% effective concentration (EC 90) was 0.081%, and the 95% CI was between 0.074 and 0.098. Among the six groups, there was one case of fetal bradycardia in group D3 and one case of decreased heart rates in group D4. No decreased blood pressure, vomiting and nausea, or postpartum headaches were reported. Conclusions:In DPEA for labor, ropivacaine plus sufentanil has an EC 50 of 0.061%, with the 95% CI falling between 0.051 and 0.067, similar to the EC 50 value in epidural analgesia.

Clinical features of 7 cases of pure spinal epidural cavernous hemangioma / 中国医师进修杂志

Objective:To study the clinical features of pure spinal epidural cavernous hemangioma in order to improve the diagnosis and treatment ability.Methods:The clinical data of 7 patients with pure spinal epidural cavernous hemangioma from January 2013 to November 2022 in Xiangyang Central Hospital were analyzed retrospectively.Results:Among the 7 patients, 2 males and 5 females, and the average age was 49.4 years old. Location of the lesion: cervical spine 1 case, thoracic spine 5 cases, and lumbar spine 1 case. One patient had pure radicular symptoms, 4 patients had pure spinal cord symptoms, and the other 2 patients had both myelopathy symptoms and radicular symptoms. T 1 and T 2 weighted images showed equal or slightly longer signals, and the enhanced scans showed uniform enhancement. Before operation, 1 case was misdiagnosed as meningioma, and the patient′s lesion was not carefully identified during operation, so the lesion was mistaken for oozing hemorrhage caused by operation; 2 cases were misdiagnosed as schwannoma. All patients underwent preoperative localization and microsurgical resection of epidural lesions through the posterior median approach. The lesions were completely removed and no significant complications were observed during hospitalization. Before operation, the neurological function Frankel grade C was in 1 case, grade D in 3 cases, grade E in 3 cases; the patients were followed up for 1 to 117 months, at the last follow-up, neurological function Frankel grade D was in 3 cases, grade E in 4 cases, no recurrence was found. Conclusions:The pure spinal epidural cavernous hemangioma is very likely to be misdiagnosed as the schwannoma and meningioma in imaging, the preoperative imaging should be carefully observed. It is recommended to inject methylene blue into the spinous process of the lesion segment before operation and locate the photos to help with precise intraoperative positioning. Once the disease is considered, special attention should be paid when opening the vertebral lamina to remove the epidural fat during the operation. The lesion is prone to bleeding, and is mistakenly believed to be absorbed by the aspirator or bitten together with the epidural fat. Total resection is an effective treatment for this disease, and it should be treated as soon as possible to avoid the influence of acute hemorrhage on the prognosis.

Effects of epidural analgesia on breast-seeking behavior and breastfeeding during breast crawling in neonates / 中国实用护理杂志

Objective:To analyze the influence of epidural labor analgesia on neonatal breast-seeking behavior and first breastfeeding.Methods:This study was an observational study. According to the cross-sectional study formula and inclusion and exclusion criteria, 150 cases of puerperas and their full-term infants who underwent vaginal delivery in the Affiliated Hospital of Southwest Medical University from March to September 2020 were included as the research objects, and the time of breast searching behavior in newborn crawling was observed and recorded. According to whether epidural analgesia was used or not, the patients were divided into analgesic group and non-analgesic group (the specific names of the two groups), and the outcome variables were analyzed.Results:There were 81 cases of successful breast crawl, 69 cases of failure, including 94 cases of epidural analgesia, 56 cases of non-epidural analgesia. Epidural analgesia had no effect on breast crawl and the time of breast searching behavior ( P>0.05). For puerperas with epidural analgesia, the total score of Breastfeeding Assessment Tool (IBFAT) and the scores of its four dimensions such as feeding time, foraging, sucking and nipple holding behavior were 9(7, 10), 3(2, 3), 2(2, 3), 2(1, 2), 2(1, 2), which lower than those non-epidural analgesia puerperas, which were 10(8, 10), 3(3, 3), 3(2, 3), 2(2, 2), 2(1, 2), the differences were statistically significant ( Z values were -6.36- -4.32, all P<0.05). Conclusions:When epidural analgesia is used clinically, medical staff need to seize the best time of drug use, pay attention to continuous monitoring of drug use duration and dosage, while exerting drug analgesia effect, it is also necessary to minimize adverse outcomes and reduce the impact of analgesics on breastfeeding.

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.

Progress of decompression surgery for spinal metastases / 中国骨伤

The spine is the most common site of bone metastases from malignant tumors, with metastatic epidural spinal cord compression occurring in about 10% of patients with spinal metastases. Palliative radiotherapy and simple laminectomy and decompression have been the main treatments for metastatic spinal cord compression. The former is ineffective and delayed for radiation-insensitive tumors, and the latter often impairs spinal stability. With the continuous improvement of surgical techniques and instrumentation in recent years, the treatment model of spinal metastases has changed a lot. Decompression surgery underwent open decompression, separation surgery, minimally invasive surgery and laser interintermal thermal ablation decompression. However, no matter what kind of surgical plan is adopted, it should be assessed precisely according to the specific situation of the patient to minimize the risk of surgery as far as possible to ensure the smooth follow-up radiotherapy. This paper reviews the research progress of decompression for spinal metastases.

Dual epidural catheters for labor analgesia in a spinal cord injury patient: a case report

Abstract Impediment to local anesthetic solution in the epidural space results in unsatisfactory pain relief during labor epidural. Patients with a history of back trauma and spinal instrumentation have increased rates of epidural failure due to patchy spread of local anesthetic with obliterated epidural space. Dual Epidural Catheters (DEC) can be used in such clinical scenarios with complete labor analgesia and improved patient satisfaction. We present the successful management of a parturient with vertebral fracture at risk for epidural failure and neurologic injury due to bone fragments and inserted cranial and caudal to the fractured vertebra using ultrasound to avoid neurologic sequelae.

The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review

Abstract Background This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control. Methods The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria. Results Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22-134.58 min; p < 0.001; I2= 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 - -5.09; p < 0.001; I2= 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40-0.64 cm; p < 0.001; I2= 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14-0.01 cm; p= 0.05; I2= 97%; GRADE: very low). Conclusions Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates.

Bloqueio epidural torácico comparado a morfina endovenosa no tratamento da dor na síndrome pós-embolização hepática: ensaio clínico randomizado controlado / Thoracic epidural block compared to intravenous morphine in the treatment of pain in hepatic post-embolization syndrome: a randomized controlled clinical trial

Introdução: A embolização e a quimioembolização transarterial hepática são procedimentos cirúrgicos usados para tratar pacientes com tumores hepáticos de origem primária e metastática, entretanto causam dor importante no período pós-operatório. O objetivo do estudo foi comparar o bloqueio epidural torácico à morfina endovenosa no tratamento da dor na síndrome pós-embolização hepática. Métodos: Foram randomizados 50 casos de pacientes submetidos a embolização transarterial hepática, os quais foram alocados em dois grupos: grupo morfina endovenosa (GV), submetido a uma dose de morfina na sala operatória; e o grupo bloqueio epidural torácico (GE), submetido a bloqueio epidural de injeção única. Todos os pacientes utilizaram analgesia endovenosa controlada pelo paciente no período pós-operatório. Foram analisados no estudo o consumo de morfina endovenosa no período pós-operatório, a dor aferida pela escala numérica verbal (ENV), o tempo de internação hospitalar, a incidência de náuseas, vômitos, prurido, retenção urinária, depressão respiratória e sonolência. Resultados: Não houve diferença do consumo médio de morfina e da ENV no período pós-operatório imediato. No primeiro dia pós-operatório o consumo médio de morfina no GV foi de 6.3 mg vs. 0.45 mg no GE, p < 0.01. A ENV no GV foi de 3.77 vs. 0.82 no GE, p<0.01. O consumo médio de morfina no período pós-operatório no GV foi de 6.91mg vs. 0.5mg no GE, p<0.01. Apenas dois pacientes do GE ficaram internados por mais de um dia, enquanto no GV oito pacientes receberam alta hospitalar a partir do segundo dia pós-operatório, entretanto não houve diferença estatisticamente significativa do tempo de internação hospitalar. Prurido foi observado em 18.2% dos pacientes do GE, e não houve ocorrência no GV, p=0.04. Conclusões: O bloqueio epidural torácico foi superior à morfina endovenosa no tratamento da dor na síndrome pós-embolização hepática.

Background: Hepatic transarterial embolization and chemoembolization are surgical procedures used to treat patients with hepatic tumors of primary and metastatic origin, however they cause significant pain in the postoperative period. The objective of the study was to compare thoracic epidural block with intravenous morphine in the treatment of pain in hepatic post-embolization syndrome. Methods: A total of 50 patients undergoing hepatic transcatheter arterial embolization were randomized and allocated into two groups: intravenous morphine group (IG) underwent to a morphine dose in the operating room; and thoracic epidural block group (EG) underwent to a single-shot epidural injection. All patients used intravenous patient-controlled analgesia (PCA) in postoperative period. Intravenous morphine consumption in the postoperative period, pain measured by the numerical rating scale (NRS), length of hospital stay, nausea, vomiting, pruritus, urinary retention, respiratory depression and drowsiness were analyzed. Results: There was no difference in the mean morphine consumption and NRS in the immediate postoperative (IPO) period. On postoperative day 1, the IG mean morphine consumption was 6.3 mg vs. 0.45 mg in EG, p<0.01. NRS in IG was 3.77 vs. 0.82 in EG, p<0.01. Morphine consumption in post-operative period in IG was 6.91 mg vs. 0.5 mg in EG, p<0.01. Only two patients in the EG were hospitalized for more than one day, while in the GV eight patients were discharged from the second postoperative day, however there was no statistically significant difference in the length of hospital stay. Pruritus was observed in 18.2% of EG patients and none in the IG, p = 0.04. Conclusions: Thoracic epidural block was superior to intravenous morphine in the treatment of pain in hepatic post embolization syndrome.