ABSTRACT
Proper positioning of a surgical patient reduces morbidity and mortality. We describe a method of patient positioning involving elevation of the lower extremities and protection of the brachial plexus that reduces complication rates in radical retropubic prostatectomy.
Subject(s)
Posture , Prostatectomy/methods , Aged , Arm/anatomy & histology , Arm/innervation , Brachial Plexus/injuries , Cause of Death , Humans , Intraoperative Complications/prevention & control , Leg/anatomy & histology , Lymphocele/prevention & control , Male , Postoperative Complications/prevention & control , Prostatectomy/adverse effects , Protective Devices , Pulmonary Embolism/prevention & control , Risk Factors , Supine Position , Thrombophlebitis/prevention & control , Venous Insufficiency/prevention & controlSubject(s)
Analgesia, Epidural , Chest Pain/etiology , Cystic Fibrosis/complications , Fentanyl , Pleurisy/complications , Adult , Chest Pain/therapy , Female , HumansABSTRACT
The use of epidural fentanyl infusion with patient-controlled epidural analgesia (PCEA) is becoming popular for postoperative analgesia in adults. Its use has not been reported in the pediatric population. We report our initial experience with this technique in pediatric patients. The charts of all children who received epidural fentanyl infusions for postoperative analgesia between June 1991 and February 1992, were reviewed. Thirty-one patients, ages 6 to 17 years (mean +/- SD, 13.2 +/- 2.7) received epidural fentanyl infusion with PCEA for 36 operative procedures. Epidural catheters were either inserted in the lumbar (n = 14) or thoracic (n = 22) epidural space at a level based on the surgery. A fentanyl bolus of 1.38 +/- 0.43 micrograms/kg was delivered via epidural catheter just prior to the conclusion of surgery. A continuous infusion of fentanyl (0.56 +/- 0.18 micrograms/kg/h) with a PCEA bolus (0.53 +/- 0.17 micrograms/kg) available every 15 minutes was initiated in the recovery room and was utilized for 8 to 110 hours (59 +/- 27 hours). Pain and sedation were assessed by verbal descriptive scales, and side effects were noted. Alterations in dosing regimen were made for inadequate analgesia or side effects. Analgesia was assessed as excellent or good in 78% of the patients, 91% in the thoracic catheter group and 57% in the lumbar catheter group (P < .02). Patients with thoracic catheters were more likely to need their infusion and PCEA doses decreased, whereas those with lumbar catheters more often needed their doses increased (P < .05). No patient had respiratory depression.(ABSTRACT TRUNCATED AT 250 WORDS)
